BILL PRESENTED

High Speed Rail (preparation) Bill

Presentation and First Reading (Standing Order No. 57)
	Patrick McLoughlin, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Secretary Vince Cable, Secretary Iain Duncan Smith, Secretary Eric Pickles, Secretary Owen Paterson, Secretary Edward Davey and Mr Simon Burns, presented a Bill to make provision authorising expenditure in preparation for a high speed railway transport network.
	Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 10) with explanatory notes (Bill 10-EN).

Points of Order

Chris Bryant: On a point of order, Mr Speaker. You will know that the parliamentary website states officially:
	“If the Queen’s Speech is amended, the Prime Minister must resign.”
	The Fixed-term Parliaments Act 2011 has obviously changed what constitutes a no confidence motion but, historically, any amendment to the Queen’s Speech has been termed a no confidence motion.
	I raise that question because the ministerial code of conduct, which is embodied in a motion of this House, states:
	“Parliamentary Private Secretaries are expected to support the Government in important divisions in the House. No Parliamentary Private Secretary who votes against the Government can retain his or her position.”
	I understand that the Prime Minister is letting his PPSs know that they are free to vote as they wish. Does that not suggest to you, Mr Speaker, that the Prime Minister has no confidence in his own Government?

Mr Speaker: What I would say to the hon. Gentleman is twofold. If he is quoting accurately, the website is wrong and can speedily be put right. On the second point, I simply say for his benefit and that of the House that the selection of amendments has not yet taken place. He is therefore in the realm of the hypothetical. Whether he wishes to be there I cannot say, but I do not and, I trust, neither does the House.

George Galloway: On a point of order, Mr Speaker. At 3 o’clock in the morning on 6 May in Shapla square in Dhaka, the capital of a Commonwealth country, Bangladesh, thousands of sleeping demonstrators were set upon by commandos. The reports are that significant numbers of people have been killed. Have you had any indication that the Foreign Secretary wishes to come to the House and make a statement about those extraordinary events?

Mr Speaker: I have received no such indication. However, when I think of the hon. Gentleman and an issue of concern to him, I almost invariably think of dogs and bones. Therefore, I imagine that this is a matter to which he will take other parliamentary opportunities to return. We look forward with interest and anticipation.

Debbie Abrahams: On a point of order, Mr Speaker. You may be aware that last Thursday, Andrew Dilnot, the chair of the UK Statistics Authority, wrote to the Secretary of State for Work and Pensions regarding his misuse of official statistics on the benefit cap. It was found that, once again, the Department was making claims that were unsupported by official statistics. That follows similar issues regarding the Child Support Agency statistics in February, and also extends to the Secretary of State for Health and his health funding claims last December, and even to the Prime Minister’s use of official statistics last October. The Work and Pensions Committee has also—

Mr Speaker: Order. I allowed the hon. Lady to pursue—[Interruption.] Order. No assistance from anybody is required. I let the hon. Lady raise her point of order, but it was in danger of becoming an abuse. From what I heard, the matter that she raised is obviously of concern to her and to others, but is not a point of order or a matter for the Chair. There are opportunities, which I am sure she will use, to draw attention to the issue. We will leave it there.

Debate on the Address

[4th Day]

Debate resumed (Order, 10 May).
	Question again proposed,
	That an Humble Address be presented to Her Majesty, as follows:
	Most Gracious Sovereign,
	We, Your Majesty’s most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.

Health and Social Care

Jeremy Hunt: In challenging circumstances, the NHS is performing extremely well. Front-line staff are making heroic efforts to control costs as they cope with the pressures of an ageing population and when 1 million more people are using A and E every year than at the time of the last election.
	The Opposition run down NHS performance, but the reality is a service delivering more than it ever did on their watch: 400,000 more operations every year than under Labour; the number of people waiting more than a year for an operation down from over 18,000 in May 2010, to just 665 at the end of February; MRSA infections halved; mixed-sex accommodation nearly abolished; dementia diagnosis rates going up; and more than 28,000 people receiving life-saving drugs from the cancer drugs fund that Labour refused to set up. As we debate health, care and support today, I take the opportunity to commend and thank all the dedicated professionals who work extraordinary hours, day in, day out, for their part in making this happen.
	If we are to prepare for the future, however, we need to do more. In our generation, the number of over-85s will double, the number of people with dementia will pass the 1 million mark, and 3 million people will have not one, not two, but three chronic conditions to cope with, on top of the other pressures of old age. We must be there for each and every one of them—the founding values of the NHS would accept nothing less—and to do so we must be able to answer three big questions: how can we be certain that people receive compassionate care even when they are not able to speak for themselves; how can we deliver joined-up care to people who use the NHS and social care system on a regular basis; and how can we ensure that sustainable funding is in place for care and support?

David Tredinnick: The Secretary of State will be aware of widespread concern among the herbal medical community that there is no statutory regulation on that area in the Care Bill. Does he agree that if polymorbidity is to be dealt with we must have firm regulation, and that just licensing herbs, as the European Union wants, would destroy the industry?

Jeremy Hunt: My hon. Friend follows such matters extremely closely and I reassure him that the Government will update the House on that issue very soon.
	The Care Bill will take a critical step forward in addressing each of the big questions that I raised, so let us consider how. First is compassionate care. Labour’s target culture led to warped priorities in our NHS and appalling human tragedy. No one disputes the value of targets, and the four-hour target played an important role in improving A and E departments. We do not, however, need targets at any cost, as we saw at Stoke Mandeville, Maidstone and Mid Staffs.

Stephen Timms: I agree with the Secretary of State about the value of the four-hour target. Is he disappointed, as I am, that that target has so often been missed in major A and E units over the past few months?

Jeremy Hunt: I am pleased that we hit our A and E target in the NHS last year, but disappointed that in Wales, which is controlled by the Labour party, the A and E target has been missed since 2009. Those on the Opposition Front Bench still refuse to condemn that.

Toby Perkins: Will the right hon. Gentleman give way?

Jeremy Hunt: I will make some progress.
	Even worse, when signs of how the targets policy was going wrong became clear, Labour’s response was to ignore or cover up the findings.

Andy Burnham: Rubbish!

Jeremy Hunt: The right hon. Gentleman says “rubbish” from a sedentary position, but the Francis report—if he read it—mentioned 50 warning signs that were missed by his Government about Mid Staffs. He himself rejected 81 separate requests for a public inquiry into what happened. The Labour party created a lame duck Care Quality Commission, unable to speak out or force change, and an NHS where too often the system was more important than the individual.

Andy Burnham: At the outset, will the Secretary of State correct the record and remind the House that it was my decision, two months after being appointed Secretary of State in June 2009, to appoint Robert Francis to conduct an independent inquiry?

Jeremy Hunt: The right hon. Gentleman’s decision not to have a public inquiry that revealed extremely important information has meant that we are finally addressing the issue that his Government failed to address.
	The Care Bill will include a vital element of our response to the Francis report, including regulatory clarity on who is responsible for identifying problems, driving up standards, and operating a single failure regime when urgent changes are not made.

Anne McIntosh: My right hon. Friend will be aware that there have been teething problems with the 111 telephone service, which could be an essential tool to treat people in their own homes, certainly for palliative care. Will he provide stringent new guidelines to all providers to ensure that such teething problems are addressed and to enable the 111 service to operate as it should?

Jeremy Hunt: My hon. Friend makes an important point. Teething problems have led to unacceptable levels of service in some parts of the country, which we are in the process of sorting out. As we sort them out, we also need to look at the long-term causes of the problems of out-of-hours provision and the fact that the general practitioner contract of 2004 has led to a removal of GP responsibility for out-of-hours care, which means that there is much less public confidence than there needs to be in the whole picture. We need to sort that out, too.

Joan Ruddock: Will the Secretary of State give way?

Jeremy Hunt: I will make some progress, then take more interventions.
	The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.

Barbara Keeley: Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.

Jeremy Hunt: We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.
	The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.

Joan Ruddock: I am grateful to the Secretary of State—out-of-hours is relevant to my point. He will be familiar with Newark. He closed the A and E department and the rate of deaths among local residents went up from 3.5% to 4.9%. Why does he therefore persist in saying that, if he downgrades Lewisham A and E, 100 lives will be saved across the south-east of London?

Jeremy Hunt: Because that is what the independent medical advice I have received has told me. The right hon. Lady should be very careful about the Newark statistics, because the increase in mortality rates, which is worrying
	and should not happen, happened before the A and E was downgraded. It is very important that we do not get the figures wrong.

Jim Dowd: Will the Secretary of State give way?

Jeremy Hunt: I am going to make some progress.
	Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

Andy Burnham: I am grateful to the Secretary of State for giving way, but the trouble with him is that, often, there is a huge gap between the rhetoric he comes out with at the Dispatch Box and the reality on the ground. He says he is promoting integrated care, but what does he say about the pioneers of integrated care in Torbay, who are threatening to take legal action because of the requirement for compulsory competitive tendering of services? Under this Government, are not the beacons of integration being demolished by his free market?

Jeremy Hunt: It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

Jim Dowd: Will the Secretary of State give way?

Jeremy Hunt: I am going to make some progress.
	The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.
	Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.
	In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.

Sheila Gilmore: I respectfully suggest that the Secretary of State should look at the situation north of the border, where reform to change who pays has worsened the situation because no extra funding was put into care; all that happened was that we shuffled around who actually paid. Will he look carefully at that situation so that it is not repeated? How much extra funding is he going to put into the system?

Jeremy Hunt: I agree with the hon. Lady that the amount of financial support is important. I gently say to her that her party wants to cut the NHS budget, which would make the situation vastly worse.
	The Bill is a vital element of our plans to improve the lives of the frail and elderly and of people with long-term conditions and disabilities, but it is only one element. Other areas that do not require legislation will come together in a plan for vulnerable older people. The plan will consider all aspects of how we look after older people most in need of support from the NHS and social care system. It will look at how our hospitals are set up to support frail and elderly patients, particularly those with dementia, in emergencies. Of course, we must continue to give people with serious needs immediate access to highly specialised skill, but in many cases we could offer better alternatives outside hospital. That would improve clinical outcomes and reduce pressure on A and E departments.
	Secondly, the plan will look at primary care—in particular, the role of GPs in supporting vulnerable older people. Active case management of vulnerable people is making a huge difference in some parts of the country and we will look at whether the primary care sector as a whole has the incentives, investment and skills to deliver that. We will also consider the provision of out-of-hours services and how to restore public confidence in them following the disastrous changes to the GP contract in 2004.
	Thirdly, the plan will look at the barriers and incentives that prevent joint commissioning and stop people from getting joined-up care. In particular, it will consider the operation of financial incentives in the system, which can act as an unnecessary and counter-productive barrier. The Minister responsible for care, my hon. Friend the Member for North Norfolk (Norman Lamb), who is leading on integration, will announce further practical steps forward later this week.
	I intend to announce the plan in the autumn, with implementation from April 2014. It will require a great deal of careful work, ask difficult questions and make tough decisions, but if it leads to more personal, more integrated and more compassionate care, it will stand alongside the Care Bill as an important step forward in reforming the care received by millions of people.

Dave Watts: Does the Secretary of State agree that that can work only if social services budgets are increased? Where will the resources come from to deal with the problems we face, and will there be an increase in social services budgets to pay for the services we need?

Jeremy Hunt: There is currently a difficult environment for public finance, for which the hon. Gentleman’s party bears considerable responsibility. The Labour party has given up on the budget; it says it wants to cut the NHS budget. We say that these changes are possible without cutting the NHS budget and in dealing with the inefficiencies caused when care is not joined up. Taken together, the measures represent more progress in three years than the Labour party made in 13 years. They represent our determination to prepare the country for the consequences of an ageing population.

Huw Irranca-Davies: The right hon. Gentleman knows that the cap on costs of care is a little way off the Dilnot proposals. How many weeks—surely his Department has made some calculations—would that involve for a typical older person before they reach the £72,000 cap?

Jeremy Hunt: The point of a cap is not that we expect everyone to have to pay £72,000 towards their care. First, through pension plans and insurance policies people can make provision so that they never have to pay that £72,000. Secondly, as part of the package, we are increasing the threshold, below which the Government help, to £118,000—much higher than it is currently—so that it will be available to help, I think, around 40,000 more people than are currently helped because of the level of the means-testing threshold.

Chris Bryant: Will the right hon. Gentleman give way?

Jeremy Hunt: No, I am going to make some progress.
	Finally, the values of the NHS—compassionate care and free at the point of need—are its greatest asset, but they open it up to risk of abuse from health tourists coming to this country to exploit that generosity.

Chris Bryant: Will the right hon. Gentleman give way?

Jeremy Hunt: I am going to make some progress.
	Over the summer, we will consult on proposals to make the system fairer and ensure that people who should pay for NHS services do in fact do so. That will also help to ensure that our NHS remains sustainable at a time of tight public finance.
	These proposals represent our commitment to ensuring a compassionate, fully integrated and sustainable system of health and social care built entirely around the needs
	of the patient. They represent a commitment to the NHS and social care system, which lies at the heart of our determination to make Britain the best country in the world to grow old in.
	[Interruption.]

Mr Speaker: Order. It is not altogether obvious whether the Secretary of State is giving way or has concluded his speech. [Interruption.] He has concluded his speech. It is usually helpful to have some indication of that.

Andy Burnham: Like you, Mr Speaker, I am tempted to say, “Is that it?” I suggest to the Secretary of State that he starts reading the weekend newspapers. He began with complacent statements about how everything is marvellous and it is all going so well, but it will not feel like that to staff working in A and E. The Secretary of State’s statement will just confirm to them that he is completely out of touch.
	Every day brings new signs of an NHS in distress: more ambulance queues outside A and E; more patients left waiting for a call-back by a 111 service ill-equipped to deal with their needs; more older people seeing social care support withdrawn, or struggling to pay spiralling care charges and ending up in A and E; more patients waiting hours in A and E on trolleys in corridors; and more hospitals running way beyond safe occupancy levels. This is the fragile state of the NHS today: battered and bruised by a reorganisation that nobody wanted and nobody voted for; an entire health and care system on the brink, facing huge challenges that require urgent answers. However, we will not find them in this Queen’s Speech. There is no answer to the collapse of social care, and no answer to the understaffing of hospitals or the growing chaos in A and E. On the preventable deaths and health harm caused by smoking and alcohol, there is silence.
	This Queen’s Speech is the product of a dysfunctional Government who have lost any ability they once had to face up to the big challenges the country faces. It cements the impression of a failed coalition project now preparing the ground for the next election rather than governing in the national interest. What else could explain the pathetic spectacle this weekend of Government Members, spooked by UKIP, falling over themselves to say that they will be voting against their own legislative programme? Has this place ever seen something so ridiculous?

James Duddridge: Will Labour give us a referendum?

Andy Burnham: I thought the new compassionate Conservative party was meant to have stopped “banging on about Europe”—that was the phrase, was it not?—but now its Members are all dancing to UKIP’s tune and reading out what Mr Crosby gives them. It will not wash. The country can see that this is a shambles of a Government who look ridiculous to the country they purport to govern. When Britain needed leadership, it got the farce of this coalition. There is no need to send in the clowns; they are already here.

Toby Perkins: Does my right hon. Friend think, like me, that perhaps the Government feel more comfortable exposing their divisions on Europe than facing up to
	their record on the NHS, which, as many people across the health service recognise, is an absolute disgrace?

Andy Burnham: I shall come to that point directly, because the Queen’s Speech is a diversion from the real issues, an attempt to say, “Look over here at this other issue” and divert people’s attention from the chaos the Government have visited on the NHS.
	On health and care, our objection is not to the modest measures the Government are proposing. We will of course wait to see the detail, but it sounds as though we will be able to give our support to many of them. Our objection to the Gracious Speech is not to what is in it, but to what is not in it and to the unpleasant political strategy that lies behind it. As a response to the developing crisis in our health and care system, it is inadequate. Worse, however, it tries to disguise that fact by pointing the finger at others. Forget compassionate Conservatism; this is straight back to the dog-whistle tactics—failed tactics, I might add—of the 2005 general election. This is the coded message the Government want the Queen’s Speech to send: “You see all those problems with accident and emergency departments? Well it’s all down to immigration. It’s nothing to do with us.” It is a Crosby-fied Queen’s Speech that is more about positioning and politics than a serious programme for government.

Edward Leigh: On a real issue that concerns people, there have been 1.1 million immigrants from eastern Europe since 2004, so I repeat the question very courteously put by my hon. Friend the Member for Rochford and Southend East (James Duddridge). The right hon. Gentleman talks about leadership, so will he show some and tell us whether the Labour party would grant the British people a referendum on Europe? Yes or no?

Andy Burnham: It is interesting, isn’t it? Here we are, in the middle of this Parliament, discussing the Queen’s Speech and health and social care, and what is the only issue Conservative Members can raise? Europe! We are talking about people waiting hours on end in A and E, about ambulances queuing outside, about a 111 service that does not ring anybody back, and about social care close to collapse, but they have nothing to say about those issues. Instead, they bang on about Europe. That is because they are preparing the ground for the 2015 election. The nasty party is back, scapegoating vulnerable people and stoking social division as a means of diverting attention from its own record, so get ready to hear how problems in the NHS are caused by health tourism and are nothing to do with the coalition’s toxic medicine of fragmentation, privatisation and budget cuts.

Chris Bryant: Is there not another side to the argument about immigration in relation to the NHS, which is that many of the people who keep the NHS functioning are from outside this country? One of the biggest problems facing accident and emergency departments around the country is that they cannot recruit enough consultants, yet the system that the Government have introduced on migration for those people is making it more difficult to recruit overseas. Would not a more enlightened attitude give us a more effective NHS?

Andy Burnham: As ever, my hon. Friend says it more eloquently than I can. The Government are playing politics rather than addressing the national interest. People will see that, but at least the Government have revealed their hand. We will work hard over the next two years to show who is really to blame and expose this Government’s failures on social care, the NHS and public health. Let me take each in turn.
	At face value, the social care measures that the coalition is proposing sound like progress towards a fairer and simpler system. Indeed, the Care Bill builds on many of the recommendations of the Law Commission’s review of adult social care legislation, which was initiated by the last Government and included in the White Paper I published before the last election. National standards for eligibility could help to bring consistency to the care system, and stronger legal rights for carers are long overdue, as is improved access to information and advice. However, the question in the minds of many today, particularly councillors watching this debate, will be: how on earth will we be expected to pay for all that? That is when we realise again that there is a huge gap between the rhetoric we hear from the Dispatch Box and the reality on the ground across England. More than £1.3 billion has been cut from local council budgets for older people’s social care since this Government came to power.
	Just last week, the Association of Directors of Adult Social Services said that Government cuts to care and councils would mean a further raid of £800 million from care budgets in the next year. The Care and Support Alliance has said that the system is in deep crisis and that without
	“appropriate funding for the social care system…the aspirations set out in the Care Bill will not be reached.”
	The Care Bill does nothing for people who face a desperate daily struggle to get the support they need right now, with many paying spiralling charges for their care. That is the effect of this Government’s drive to cut councils to the bone. They are foisting huge care charges on the most vulnerable people in our society. These are the coalition’s dementia taxes.

John Glen: Does the right hon. Gentleman not understand that the people of this country would have more confidence in what he says at the Dispatch Box had he not said in the last general election campaign that it would be irresponsible to safeguard the NHS budget, which is what this Government undertook to do?

Andy Burnham: I will come directly to that quotation in a moment, because the hon. Gentleman will remember that at the last election he stood on a manifesto promising real-terms increases for the NHS. I hope that when he speaks later—or if he wants to get up right now—he will tell me whether they have been delivered.

John Glen: I am grateful for the opportunity to acknowledge the great difference between England and Wales, where Labour is in power and where we are seeing real cuts in NHS spending.

Andy Burnham: Government Members are just embarrassing themselves. When they cannot answer a question, they try to raise another one or go on about
	Europe. It is just not good enough. The answer is—though the hon. Gentleman cannot admit it—that Andrew Dilnot said this Government had cut the NHS. It is there in black and white. That is what they have done, and they stood on a manifesto promising the opposite. I secured a budget to protect the NHS at the last election. I said that I could not give real-terms increases because that would be irresponsible; and as it turns out, nor can the hon. Gentleman. His party was writing cheques that it simply could not cash, and that is a fact.
	The Care Bill does nothing for those hit by the coalition’s dementia taxes right now. Since this Government came to power, the average care user has paid £655 a year more for home care than when they came into office. Overall, that is around £6,800 a year. Dial-a-ride transport services have doubled in price over the same period, from an average of £1.92 to £4.12. Meals on wheels now cost an extra £235 a year, while people in Conservative areas pay more for each service on average than friends and family in Labour-controlled areas—on average, £15 a week or £780 a year more for home care. That is the record of this Government.

Stephen Mosley: rose—

Andy Burnham: I will give way one last time.

Stephen Mosley: The right hon. Gentleman has been speaking for more than 10 minutes and he has not once said what Labour would do. Will he come to what the Opposition propose we should do?

Andy Burnham: I assure the hon. Gentleman that I will come on to that, but I have a job to do in holding this shambles to account and that is exactly what I am doing.
	Under this Government, people are paying more out of mum or dad’s bank account for care, which often does not come up to the standards that they want, because their council has been cut to the bone. What are they meant to make of a promised, far-off cap of £72,000, or £144,000 for a couple? The Government are giving a little with one hand, while with the other they are grabbing a fortune from people’s bank accounts.

Barbara Keeley: Does my right hon. Friend acknowledge that this is not even a question of £72,000 or £144,000, because those caps will be metered at the level that the council would pay, and will take no account of top-ups or accommodation costs? I have seen examples that show that people might have to pay £250,000 before they get anywhere near the cap and any help from the state.

Andy Burnham: My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.
	How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a
	question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

Jeremy Hunt: indicated dissent.

Andy Burnham: That is what this Government are doing. A cap is ineffective without long-term funding for the future of social care, and the failure to face up to the crisis in adult social care budgets that Conservative councillors are talking about will leave people with the impression that this Health Secretary is fiddling while Rome burns. The social care system in England is close to collapse, and the reality behind the Government spin is that, under this Government, people’s savings are being washed away more quickly than ever before.
	I want to turn now to our accident and emergency services. The crisis in social care is the predominant driver of what we are now seeing in our accident and emergency departments. If people’s services are withdrawn, or if they cannot afford to pay for them, they are more likely to struggle and fall ill at home and to end up in hospital. That is bad for them, and it costs the NHS more. Also, NHS staff are finding that people who are ready to leave hospital cannot be discharged because the necessary support cannot be put in place. Beds are not being freed up on the wards, and A and E therefore cannot admit people to the wards because there is no space. A and E then becomes full, which results in ambulances queuing up outside because they cannot hand over patients. The system is now backing up right through A and E.

Jeremy Hunt: indicated assent.

Andy Burnham: The Secretary of State is nodding; he should do something about it. This is happening on his watch. Across the country, hospitals are operating at levels way beyond safe bed occupancy—[Interruption.] He nods, but I am saying, “Do something. Don’t just nod!” We need action from the Secretary of State.
	Let me return to the quote that I mentioned earlier. People love to say that I would have cut the NHS. For the record, I have never said that I would cut the NHS. At the last election, I promised real-terms protection for the NHS. The Conservatives promised real-terms increases, which have never been delivered. Let me read that quote in full:
	“It is irresponsible to increase NHS spending if the effect is that it is damaging, in a serious way, the ability of other services to cope…that are intimately linked to the NHS. The health service needs functioning day care, and housing”
	and meals on wheels.
	That warning has now come true.

Jeremy Hunt: rose—

Andy Burnham: I will give way to the Secretary of State, but I ask him to address this point. He has paid for the so-called ring fence on the NHS by ransacking local government funding, and that makes no sense whatever.

Jeremy Hunt: If the right hon. Gentleman looks at the figures, he will see that real-terms spending on the NHS has gone up since Labour was in power. Given that he thinks it irresponsible to increase the NHS budget, does he agree that if he were to follow his own policy, he would now need to cut that budget from its current level? That is Labour policy.

Andy Burnham: I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.

Hugh Bayley: Surely the Secretary of State has forgotten that he received a letter in December from Andrew Dilnot, the chair of the UK Statistics Authority, which said that
	“we…conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10…In light of this, I should be grateful if the Department of Health could clarify the statements made.”

Andy Burnham: I am very grateful to my hon. Friend. He has now embarrassed the Secretary of State who, just a moment ago from the Dispatch Box, claimed the opposite. Similarly, the Work and Pensions Secretary was pulled up last week for doing exactly the same thing. They think they can stand there and say whatever they like, and they think they can get away with it, but they cannot, because people have seen through them. They have cut the NHS; they have broken the central promise on which this Government came to office. Now they are saying that the pressure on A and E has nothing to do with social care funding or NHS funding, but is all to do with the GP contract in 2004. That is what they have been saying on the radio for the last three weeks.
	Let the Government answer this. In 2009—five years after the GP contract came into force—98% of people were seen within four hours at A and E departments across England. What we have seen recently is that, week after week, major A and E units are missing their lowered target. That is the reality right now, and the Secretary of State had better start facing up to it.

Joan Ruddock: My right hon. Friend will have heard me refer to the situation in Newark, when intervening on the Secretary of State. Does my right hon. Friend agree that when a promise is made that closing or downgrading an A and E will save lives, that is what one logically expects to happen? The fact that the death rate subsequently went up is an indictment of what the Secretary of State has done. Does my right hon. Friend agree that when we cannot meet the four-hour target for A and E throughout the country, it is ludicrous to close existing, well-functioning A and E units?

Andy Burnham: I could not agree more with my right hon. Friend. All over the country, we hear that A and E is under intense pressure. Such is the importance of these services to every community that changes should be made only if there is a compelling clinical case to support them. If clinicians can demonstrate that more lives will be saved and disability will be reduced by changing A and E services, I think every Member
	should have a morally obligation to support them, but when the changes are financially driven—my right hon. Friend knows this better than anybody, as the Secretary of State has downgraded a successful A and E in Lewisham to deal with problems in another trust—that simply will not do. A and E units in west London, for example, are being closed one after another. That is not good enough, and neither is it good enough in Greater Manchester, where huge changes are planned. These changes must be clinically driven, not driven by finance, which is what we are seeing under this Government.

Dave Watts: rose—

Andy Burnham: I will give way one last time, before making some progress.

Dave Watts: I am grateful to my right hon. Friend, who is rightly concentrating on A and E units and social care. Does he agree with me that many hospitals around the country are facing a financial crisis, too, where the Government are refusing to fund anything other than consultancies? In my area, that has meant spending hundreds of thousands of pounds to tell us what we already knew—namely, that my hospital is underfunded.

Andy Burnham: That is what happens when a market is set up in the NHS, pitting one hospital against another in open competition. That is what is beginning to take hold in the NHS, where the Government waste money on consultants and all the other things that come from bidding for contracts. That is a direct effect of the legislation they pushed through. This reorganisation and the budget cuts I mentioned a few moments ago are providing a toxic mix. This is why for 32 weeks running, the NHS in England has missed the Government’s own lowered A and E target for major units. It really is time that the Health Secretary got a grip on the issue. We hear that last week he was trying to hatch a panic plan to deal with the A and E crisis. That is the reality of what was going on behind this threadbare Queen’s Speech: the Health Secretary was trying to cobble together a plan to deal with the A and E problems, weeks after we had first raised the issue in the House.
	We hear of an e-mail leaked by an NHS finance officer which said:
	“The SoS would like to announce tomorrow that £300m-400m is being invested to solve the A&E problem. We have spent most of the day trying to hold him off doing this.”
	The Health Secretary seems to have forgotten that his powers to intervene were given away by his predecessor. He no longer has the power to mandate the NHS to do what he wants; the NHS can now “hold him off”. I am afraid that he looks weak. He has no response to what is happening to A and E departments. And where is the “£300 to £400 million” plan? It has not materialised. That is proof that when the Government surrendered their powers of control over the NHS, the Health Secretary surrendered his ability to do anything about the problems that we now face.
	It is just as bad when it comes to staffing. We hear that nurses’ posts continue to be lost. Nearly 5,000 have been lost since the Government came to power, and according to the findings of a survey published yesterday, nurses fear that further tragedies could happen as a
	result of staff losses. That should set alarm bells ringing throughout the Department of Health. The Care Quality Commission has said that one in 10 hospitals in England does not have adequate staffing levels. The Health Secretary nods. I am glad that he accepts that, but, again, what is he going to do about it?
	I welcome the fact that the Care Bill will contain measures relating to the Francis report, and I will work with the Health Secretary on that, but let us get to the crux of the issue of safe staffing levels, because that is the most urgent problem facing the NHS. The Health Secretary nods again. Let me make him an offer. If he introduces a benchmark—if he specifies minimum staff to patient ratios—we will support him, and the measure will go straight through the House. I shall wait for him to respond to that offer, and to ensure that the recommendations of the Francis report are properly implemented.
	I give a cautious welcome to some of the Health Secretary’s measures to deal with health tourism, but let me issue two caveats. First, it is important not to overstate the nature of the problem, and secondly, it is essential for health practitioners not to be turned into immigration officers. In March, when asked how much health tourism was costing the NHS, the Health Secretary said:
	“I don’t want to speculate… but… we have heard… it’s £200 million.”
	On the same day, the Prime Minister’s spokesman said he believed that the figure was more like £20 million. Perhaps the Health Secretary could account for the difference—or did he just add a zero?

Stephen McCabe: Would it not be helpful if the Health Secretary could tell us exactly how much he thinks is being lost and what it will cost to try to recover the money? At present the only figure that he has is the one on the invoices, rather than one relating to the money that is actually recovered.

Andy Burnham: We must wait to see what the Government produce, but we need to be sure that they are attacking the real problem rather than playing politics with an issue and creating the impression that all the A and E problems are caused by immigration. If that is their real intention, they will have no support from the Opposition.

Chris Bryant: Did my right hon. Friend have an opportunity to hear what the Conservative right hon. Member for Haltemprice and Howden (Mr Davis) said during the debate on the Queen’s Speech last week? It was very intelligent and nuanced. He said that it was necessary to ensure that not just life-threatening diseases but notifiable diseases and mental health conditions would not be covered by the proposed measures. The position is not quite as straightforward as some newspapers might like to suggest.

Andy Burnham: Nuance, care and caution are precisely what we need in this debate; we do not need press statements written by Lynton Crosby which then turn up in the House as Bills. We want responsible government, ensuring that the NHS is not abused. We will support the Government as long as that is their intention, but if they are doing something more sinister and playing politics with these issues, they will not have our support.
	We have had no answers on the NHS. Let me finally turn to public health. There was not much on which I agreed with the last Health Secretary, but he had my strong support when he spoke about tackling smoking. He said that he wanted tobacco companies to have “no business” in this country, and that introducing standardised packaging was an essential next step to ensure that young smokers were not recruited by the tobacco industry. [Interruption.] The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), looks confused, but I think she advanced the same argument on the radio a couple of weeks ago, saying she was an advocate of standardised packaging. Then, we read in advance in our newspapers that the measure had been dropped—one of the “barnacles” on “the boat”, we were told, by the said Mr Crosby. This is the same Mr Crosby who has represented “big tobacco” since the 1980s, who masterminded the campaign against standardised packaging in Australia, and who was federal director of the Liberal party of Australia when it accepted millions of pounds in donations from the tobacco industry.
	The Secretary of State said last week that a decision has not been made yet because the consultation has only just finished. It ended nine months ago. He can make a decision. I say to him again today, here is another positive offer from the Opposition: if he brings forward these proposals, they will have our full support and we will get them on the statute book.

Ian Mearns: My right hon. Friend may be interested to learn that the Prime Minister wrote to me about plain packaging before the Queen’s Speech was delivered to both Houses. He said in that letter that there were currently no proposals to introduce plain packaging.

Andy Burnham: The former Secretary of State said that it was full steam ahead and that is what they would do. This Secretary of State comes in and says nothing about the issue. Then, a right-wing Australian lobbyist arrives, and all of a sudden no one mentions it at all. Has the Secretary of State ever met Lynton Crosby and discussed this issue with him? I think we have a right to know. [Interruption.] He nods; I should be interested to know the substance—[Interruption.] He has not met him to discuss the issue. He looks very uncomfortable all of a sudden.

Jeremy Hunt: Just to put the right hon. Gentleman out of his misery, I have not discussed this matter on any occasion with Lynton Crosby.

Andy Burnham: We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.

Jackie Doyle-Price: I appreciate that the right hon. Gentleman has very clear convictions and a desire to tackle smoking as a public health issue.
	However, a third of cigarettes smoked in London are contraband. How would standardised packaging deal with that problem?

Andy Burnham: I agree that we need to do something about that, and we did bring forward measures in government, but standardised packaging is not plain packaging: it is about having designs on the pack that could be used to ensure there is no counterfeit tobacco. Surely some things are more important—the young smokers in the hon. Lady’s constituency and mine who are targeted by the tobacco industry. Surely we in this House can unite on issues such as this and take steps to improve the long-term health of the country. It seems to us that the Government have given up on the health of the nation.
	I said I would set clearly out for the House what I would do had I been standing at the Government Dispatch Box today. For a start, I would have introduced a Bill to repeal the disastrous Health and Social Care Act 2012, which has placed our NHS on a fast track to fragmentation and privatisation. That Bill would have restored the powers and responsibilities that the Secretary of State’s predecessor gave away, and which he found out last week he no longer has. I would legislate for the full integration of health and social care as the only realistic answer to the challenges brought by the century of the ageing society.
	People can see that increasingly it is the Opposition who have the courage and the answers to deal with the big challenges the country faces, not a failed coalition that is now playing out time. Its toxic medicine of cuts and reorganisation has laid the NHS low, and now it has no answers to the chaos it created. That is because the Secretary of State only discovered last week that his own reorganisation had stripped him of his powers to intervene, leaving him looking weak—in office, but not in power. Having done that, the Government’s answer is to try to scapegoat others for problems of their making. It will not work—we will remind people that it was a right-wing reorganisation that has left the NHS destabilised and demoralised. We will never tire of reminding the Prime Minister that the British people never gave him their permission to put the NHS up for sale, and we will restore the right values to the heart of our NHS—compassion before competition, integration over fragmentation, people before profits. The NHS and the country deserve better than a Government who are out of touch and out of ideas.

Nicholas Soames: I am grateful for the opportunity to speak in the debate on the Address.
	In nearly 30 years in the House, it has been my experience that Governments are always accused of having either too much or too little in their Queen’s Speeches. As my hon. Friend the Member for Banbury (Sir Tony Baldry) rightly said in his excellent contribution, however, they are works in progress. I congratulate the Government on bringing forward a measured and carefully thought-out programme, which has been welcomed by my constituents and which will make a positive contribution to the lives of many of our fellow citizens. The immigration measures, the national insurance contributions Bill and the deregulation Bill are particularly important to the
	work that the Government are doing—in my view far more successfully than they are being given credit for—in fixing the British economy, which is showing clear signs of real improvement.
	I would like to report to the House that at the Burgess Hill Business Parks Association business exhibition on Friday there was a solid mood of determination to grow our local economy, as well as considerable satisfaction at the progress being made. The message that I take back from that admirable gathering is one that all our colleagues will find when they go to gatherings of that type: people want the Government to press on with getting rid of regulation and bringing in lower taxes—above all, they want to get on with growth. This Queen’s Speech presses on with a number of key reforms on welfare, on education and by the Home Secretary in her excellent work on immigration.
	We were fortunate to have exceptionally good local election results in Mid Sussex, where the combination of a prudent and well-run West Sussex county council and an extraordinarily efficient and well-led district council have delivered with confidence the Government’s agenda, which is welcomed and well understood. What is clearly most important locally, however, is the state of the economy. For all of us, that must be at the very top of all our constituents’ concerns about the future of the country. Our constituents want the Chancellor and the Prime Minister to press on. If they do and the economy grows, much of the country’s serious anxieties will begin to disappear like the winter snow.
	I am delighted that my right hon. Friend the Prime Minister is in Washington today with President Obama in our pursuit of the European Union-United States free trade agreement, which is clearly extremely important to our future, not only for our national trade and commerce in Europe and elsewhere, but as a mark of stability in world trade, which is vital to the ordinary conduct of economic and world trade growth. All of us here know that the opportunities in that regard are enormous.

Robert Walter: Does my right hon. Friend agree that if we were to vote to leave the European Union, we would no longer benefit from that free trade agreement?

Nicholas Soames: I do agree, but I will come to that point in a moment, if I may.
	As co-chairman with the right hon. Member for Birkenhead (Mr Field) of the cross-party group on balanced migration, I warmly welcome the considerable progress that the Government have made on the difficult and sensitive matter of immigration. They have succeeded in driving down numbers and there is real progress, but there are no easy solutions. I welcome the carefully thought-out work of my right hon. Friend the Secretary of State for Health on those services. The cross-party group, and I think most of the House, knows that the most careful attention must now be paid to the question of access to benefits and the health service. Thus, the immigration Bill is an important step forward.
	I know the Government do not underestimate the anger and frustration that many people feel about too many people arriving in Britain and accessing public
	services before they truly should. To that end, I will conclude by saying a few words about the European issue.
	The House knows that I am a staunch but not uncritical pro-European. I acknowledge the profound frustration of dealing with Europe, and there are certainly the most serious problems with the European Union that we must fix. The Conservatives are committed to doing that. In many of these matters, we will find solid support across the continent from our European partners, and my right hon. Friend the Prime Minister will do that.
	People need to understand that the Prime Minister has committed to the negotiation of a new settlement between Britain and the European Union. People questioned whether he would veto an EU treaty, but he has vetoed an EU treaty; people questioned his ability to get the EU budget cut, but he has succeeded in getting it cut; and people questioned his ability to get powers back from the EU, but the fact is that he got us out of the EU bail-out mechanism and saved this country hundreds of millions of pounds.
	The Prime Minister has said that he is committed to negotiating a new settlement for Britain within the EU and I have every confidence that that is precisely what he will achieve. It will be then for the British people to judge that settlement in a referendum. There will be a referendum on our membership of the EU; the commitment on that is absolute. Some of my hon. Friends and indeed some of my right hon. Friends need to be a little cautious about trivialising what is involved. The decision on a referendum is hugely important for this country; it is probably the most important decision that it will have to take for generations. It is not to be lightly taken, or on the basis of prejudice or pub rhetoric.

Gerald Howarth: Will my right hon. Friend give way?

Nicholas Soames: No, I will not. No good is done to the public governance of this country by a constant chipping away at trust and at the Government’s integrity. If the Prime Minister says that something will happen, such is the momentous nature and importance of this decision that it will happen with orderly process and proper debate, and not with some hysterical, knee-jerk, publicity-seeking action.
	I beg this House to remember that, with all the EU’s imperfections and all its problems, it gives our country free and fair access to the single largest integrated economic area in the world; a single market of 27 countries and 500 million people with a gross domestic product of $16 trillion. I could not possibly look my constituents in the eye and tell them I was prepared to risk that. I urge the House to support the Prime Minister and the Government in the orderly process that has already been announced, which will result in a referendum. I am confident that it will be a positive referendum for the United Kingdom.

Frank Dobson: I will not follow the right hon. Member for Mid Sussex (Nicholas Soames) in referring to Europe, other than to say I regret the possibility that European competition
	law will in future apply to the national health service, which will no doubt be exploited by major American health corporations.
	I will talk exclusively about the current destruction of NHS Direct, a successful, safe and popular service, and its replacement by 111—I hesitate to call it a service— that has proved to be a shambles in many parts of the country. I must declare an interest—a sort of proprietorial one—because I was Health Secretary when we decided to set up NHS Direct in 1998. We set it up in a sensible way, and it worked from the start. We established three pilot schemes. The service was gradually rolled out across the country, learning all the time from the experiences of the earlier services that were already working. It worked well from the start, and there is no excuse for Ministers in this Government who have introduced the 111 service as a mess. They have been calling summits and announcing reviews ever since it started going wrong. That is pathetic, because they are not in the Department of summits and reviews; they are in the Department of Health.
	Those Ministers were not even doing anything new. They had the opportunity to build on NHS Direct, which was a successful example. In 2002, it was described as a remarkably successful service by the Public Accounts Committee, then chaired by the hon. Member for Gainsborough (Mr Leigh), and of which the current Chancellor of the Exchequer was a very active member. Reports by the Comptroller and Auditor General and the PAC commended the service, saying it had met all its deadlines and properly addressed all the risks, and that it had a practical approach and had learned lessons as it went along. It was also commended for the fact that its computer procurement had been well managed and had been delivered to cost, and that there had been satisfactory consultation and it was clinically safe.
	It was praised, too, for reducing demand on other parts of the NHS. The main reason it was reducing demand was because it was predominantly staffed by nurses, who had the professional confidence and judgment simply to offer reassurance to some who got in touch. In the current service, however, there are many call handlers, who do not have that professional knowledge and confidence, and are therefore referring people to GP services or A and E and are arranging ambulances.
	I commend the views of the PAC back in 2002. It was far sighted, because it said:
	“Departments should consider what wider lessons they could learn from the successful introduction of this significant and innovative service on time.”
	The Chancellor’s Government have clearly decided to ignore that recommendation. The PAC also noted:
	“Short lines of communication between the Project Team and those implementing the service at local level enabled lessons to be learnt quickly as the projects progressed.”
	Clearly the current Government did not learn that lesson either.
	The current Chancellor himself said in one of his contributions to the Committee:
	“My concern is that the Permanent Secretary…is going to start saying, we are great, we have this giant switchboard for the NHS, and your service is going to lose the focus of its original function”.
	That perfectly describes what has happened with the abolition of NHS Direct and its replacement by the 111 service.
	The 111 service does not have short lines of communication—indeed, I doubt whether it has any at all. It has also taken on innumerable new functions, and has been expected to carry them out at less cost than NHS Direct was operating at. The only way it could reduce costs was by getting rid of nurses, because they are more expensive than call handlers. Indeed, GP representatives have told me the current service has reversed the situation: whereas there used to be more nurses than call handlers, there are now more call handlers than nurses, and in one area there are 15 call handlers and one nurse.
	The computers keep going down, there are massive delays, and a lot of the call handlers are giving the wrong advice, much of which is expensive for the NHS. The Government cannot say that they were not warned about this because they were warned by Members, even Government Members, as long ago as March, not this year but last year.
	In bidding to get one of these contracts, people assumed, in good faith or bad faith, that they could provide as good a service as NHS Direct at half the cost. It is now clear that they cannot. Other parts of the NHS are bailing them out to try to keep the 111 service going. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the question that arises is what the Secretary of State can do about it. The people running these services have bid for fixed-price contracts. If they now need to spend more, how is the money going to get to them so that they can do so? They are left with three alternatives: they can struggle on providing this very poor, unreliable service, they can go bust and there is no service, or the money is found from somewhere else in the NHS. However, under the crackpot system that the Government introduced when they changed the law, there is no machinery for putting extra money into these services so that they can do their job properly.

Paul Burstow: I want to concentrate my remarks on social care, because all too often in debates entitled “Health and Social Care” we tend to spend most of our time debating health, and yet our social care system is absolutely vital in regulating health care costs and delivering a better-quality health service. The Bill announced in the Queen’s Speech—it was indeed published on Friday—goes a long way towards laying some important foundations for a better social care system.
	The Care Bill attempts to address a number of long-standing flaws in the system that have developed over the past 60 years through a series of piecemeal measures enacted by successive Governments. It is essential that in considering this over the next few months we make sure that we get it right, because legislation in the social care sphere comes to the House very infrequently. Our care and support system is of key importance because the rapid age shift that is taking place in our population is profoundly changing the nature of the demands on the system. It is important to note that this is not just about ageing; it is about the complex co-morbidities of long-term health conditions, both physical and mental, that are at the heart of the serious pressures on our whole system.
	Our social care system has a number of features that need to change. It is too oriented around crisis and stutters into life when things have already gone wrong.
	It does not enable people to plan successfully for future care needs or, indeed, to prevent and postpone them. It does not provide adequate signposting, information, advice and advocacy for people to secure what they need from it, making it feel too much like a fight to get what is necessary. There is a lack of recognition of, and support for, family carers. Quality is variable around the country. We have heard announcements today about co-ordination of care and continuity, which is clearly a problem too. The costs of care are a lottery, and that needs to be addressed.
	The Bill is taking all this forward. It focuses on early intervention and prevention, with a new responsibility for that to be up front in the way that local authorities plan their services. There are new duties on information and advice. I welcome the fact that the Government have agreed that the Bill should specifically refer to financial advice as being part of the legal obligations. There are new rights for adult carers—I will talk about young carers in a moment—with a lower threshold of eligibility for services. That is very welcome. A new rating system is being established to assist with quality of care and to help providers themselves to benchmark their performance.

Andy Burnham: I know that the right hon. Gentleman is very knowledgeable on this subject, but does he believe that councils have sufficient resources to consider new rights, given that we hear that care is collapsing all over the country and the Local Government Association says that if nothing else happens councils will be overwhelmed by the costs of care in less than 10 years?

Paul Burstow: I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.
	The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.
	I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill,
	which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.
	The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

Madeleine Moon: In a previous life I was a contracting officer for a local authority, and I contracted and commissioned care from the private sector. We always faced the same problem: the local authority tried to get more care for less money. That meant that contractors were paid less for their care workers, who were constantly not paid for travel time. How do we break this vicious cycle if we do not accept that we have to fund local authorities properly to make possible the provision of quality care?

Paul Burstow: I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

Norman Lamb: I agree that the quality of commissioning needs to be addressed as well as the quality of provision if we are to get better care for the people who need it.

Paul Burstow: I welcome that comment from the Minister and look forward to seeing more detail.
	My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

David Ward: Can I tempt my right hon. Friend to comment on his proposals on the use of universal benefits for wealthy pensioners? I know that he has produced a pamphlet.

Paul Burstow: I will try to do that in the one minute and 14 seconds left to me.
	The ADASS survey paints a quite disturbing picture of the next two years. More providers will face financial difficulties and there will be increasing pressures on the NHS as social services shunt people into health care services.
	The spending review that is under way is for just 12 months. It needs to fund the successful implementation of this legislation, and not least the introduction of the Dilnot proposals. More than 450,000 people will need assessments to get into the new system. The spending review also needs to sustain the transfers of money from the NHS to social care. Beyond that, the spade work needs to be done now to make the case for the critical interdependencies between social care and health that will sustain our social care system and make our health system deliverable and affordable.
	The Queen’s Speech, with its specific commitment to this legislation, contains a landmark reform that will do a great deal to improve the quality of life of our constituents.

Ann Clwyd: I am grateful to the 2,500 people from England, Scotland, Wales and Ireland who have written to me since last December, when I first raised the issue of compassion in nursing. The e-mails keep coming and I want to quote from some of them.
	A man whose elderly mother was in hospital asked how many staff it takes to cut a fingernail:
	“The hospital staff won’t cut my mother’s fingernails. They won’t clean them properly either. The excuse given to me is that this amounts to an ‘assault on patients.’”
	My mother…has for the past several weeks been positive for a new superbug which is carried in faeces and would cause havoc if it got into the bloodstream…she’s in an isolation ward now. Barrier nursing, rubber gloves and pinnies for all staff and visitors. And still the nurses won’t do her fingernails, and they can’t or won’t see that filth under fingernails or wherever it is located, is intolerable in hospitals and needs to be eliminated—most especially in infection control units.”
	The e-mail continued:
	“I had a rant at the…staff for leaving the buzzer button and water out of reach of bedridden patients [i.e. people in beds near to my mother who were calling out to anyone for water]. My mother’s buzzer was also out of reach. I was then told these elderly patients might strangle themselves on a buzzer’s cable.
	My mother tells me that if staff are dealing with a patient [e.g. bathroom visit] when the food trolley arrives then sometimes the patient may not get any meal. It is delivered, uneaten, and taken
	away. The idea the patient might still be in the land of the living and come back to their bed later and need some food seems not to bother them”.
	A man whose father was on a ventilator wrote:
	“There were no issues with the treatment he received, but the comment I received when going to say goodbye to him when the decision was taken by medics to switch off the machine is not one I will ever forget. After going to see him and saying goodbye, the nurse—whose Christian name and face I will always remember—said to me, ‘Can we crack on now?’”
	A woman whose husband died of cancer at 53 after, she alleges, years of mistreatment and misdiagnosis wrote:
	“When I complained to PALS—”
	the patient advice and liaison service, which some hospitals have—
	“my initial complaint was ignored. So I complained to the chief exec. I had several meetings with PALS and was told they would do an independent review. This took them two years and they denied any wrongdoing. No proper investigation took place. I then contacted a solicitor and had an expert review of the case. He said the treatment was nothing short of criminal…it has taken me four years of fighting for justice. They have now finally admitted liability for breach of care and duty and causing his death. But what happens to those responsible? Nothing. This was not one mistake, it was a catalogue of errors that went on for 3 years. They should be tried for manslaughter.”
	A man whose wife suffered mistreatment wrote that
	“she was regularly left to lie in her own faeces for half an hour or longer, and on more than one occasion for well over an hour. This led to a severe rash on her backside to the point that her bottom and the backs of both thighs were red and raw. The buzzer would be left hanging out of reach, either by accident or on purpose…at one point she was lucky enough to be able to reach her mobile phone as she rang me in tears during the middle of the night asking me to ring the high-dependency unit desk as she’d been desperate for a nurse…I had to bring her a fresh bottle of water every evening so that she could sleep with it in bed as the water on her tray was often pushed out of reach after her visitors had left for the night.
	She was never weighed when in hospital despite multiple requests of both doctors and family. The staff allowed her muscles to atrophy to the point she could not even get herself out of bed…she was so badly undernourished, many family members doubted if she would ever come out of hospital.”
	A woman writing about her mother’s mistreatment stated that
	“nurses frequently chatted and laughed at the nurses’ station at night, showing a complete lack of consideration and respect for patients. Standards of cleanliness left much to be desired, and we were sometimes greeted by soiled dressings left lying around and on one occasion, splashes of blood which did not appear to be hers, left over the end of the bed. Generally there was poor liaison between the two hospitals and the GP, with outpatient consultant appointments being sent to my mother’s home address, when she was in hospital dying. We did not complain at the time as we were too distressed by my mother’s condition and after she had died unable to bear reliving her last months.”
	A man wrote to plead that the right kind of person is selected and supported for a nursing job:
	“I have seen nurses walk onto a ward chatting loudly about their social life, approach a patient and see to his needs while continuing their loud chat, apparently oblivious to the sad human bundle they were treating, as if it was a spare tyre that they were changing. I expect you have seen groups of nurses chatting at the nurses’ station and ignoring patients on their ward who are calling out for a nurse. Yes, we know, some of these will be demented or disorientated souls who do not need medical attention as such and are possibly a regular nuisance, but they are in the care of those nurses and should not be ignored.”
	A woman, who after the experience of her last operation is dreading the next one, wrote:
	“Upon being admitted I was placed in a storage area and left for hours in pain, and alone, and very frightened. A specialist came and took a cursory look and said I was to go home and come back the next day. I live alone and was very unwell to say the least. I became very upset and was treated like a naughty child. I then blacked out and upon waking I was in a bed with some very anxious nurses around me…I had blood poisoning. A nurse later stated that, ‘We have lost patients not as bad as you have been’. Later that night my abscess burst. I called a nurse who looked at the bed and then told me to sleep on a clean bit!”
	One of the biggest problems is that of patients being starved. One account describes cleaners who
	“put trays at the bottom of beds—unhygienic for a start—then come around half an hour later and lift the trays. Nobody checks to see if the patient has eaten it. It is fortunate if visitors or some of the better patients are around to help the more frail. I never saw any staff feed or help patients to sit up...I hope this is not common practice, but sadly I fear it is.”

Charles Walker: I pay warm tribute to the right hon. Member for Cynon Valley (Ann Clwyd). That was an incredibly moving speech—we could have heard a pin drop in the House of Commons throughout those eight minutes—and a fantastic contribution to the debate.
	I had intended to make a statesman-like speech, but sitting next to me is possibly one of the greatest statesmen, my right hon. Friend the Member for Mid Sussex (Nicholas Soames). I do not want to go out and bat on a losing sticky wicket, but rather to have a general thrash around the field of play. I admit to the right hon. Member for Leigh (Andy Burnham) that I am a Eurosceptic. When I came to the House of Commons, I fell into bad company, including my hon. Friend the Member for Aldershot (Sir Gerald Howarth). Indeed, when I arrived here, I was nursed at the bosom of my hon. Friend the Member for Stone (Mr Cash), so I am a Eurosceptic—[Interruption.]Anyway, I want to crack on.
	In 2011, I attended a public meeting in my constituency. We were discussing the future of an urgent care centre. Five hundred of my constituents were there for a lively debate, which ended at about 8.30 pm. I had arranged at 9 pm to travel northwards in my constituency to Hoddesdon to meet 12 or 14 Polish people. As I left the room of what I would regard as fairly natural Conservatives and got in my car to drive up the A10, I thought, “Why on earth am I heading up the A10 to meet 12 or 14 Polish people?”
	I was pleased I did. They waited in a circle to see me. We were in a recession at the time, but their eyes were gleaming and glittering. They said, “Mr Walker, this is the land of opportunity. It is fantastic. You don’t just get one job here; you can have two jobs. If you do those jobs really well and do what you are asked to do, you get promoted. This is a fantastic country.” It was so refreshing to see such enthusiasm in the room.
	We should have had transitional measures in place when the Poles came over to this country. It was not good enough to say, “There might be 15,000 or 30,000,” when 500,000 ended up coming here. That was a grave error. However, to say that the Poles are somehow
	responsible for the country’s problems is a gross simplification and a fairly disgraceful statement to make. As I have said, I wish fewer had come here, because we should have had transitional arrangements. The infrastructure was not ready to welcome 500,000 people to this country, but I cannot fault them for a second for wanting to come here.
	People say that people from eastern Europe want to come to this country to sponge off the NHS and our welfare system. The minority will, but the majority want to work hard and do the best for their families. There are rotten apples from European nations in this country, but there are quite a few rotten apples from this nation in foreign countries—hon. Members might have managed to see that a British fugitive was arrested by Spanish police yesterday on the Costa del Sol.
	Immigration is not a uniformly good thing. It tends to work for the middle classes and the upper middle classes, whatever they are now. Basically, it works for people with money. Immigrants work very hard in our restaurants and cleaning our offices. However, immigration does not work so well if people are competing for scarce resources such as health, transport and education. I understand the concerns of people who now face additional pressures on scarce resources. We did not plan well. I do not want to sound overly partisan, but—dare I say—the previous Government did not plan well for the upsurge in immigration, which has created difficulties in our constituencies and a great deal of concern.
	In my remaining three and a half minutes, I want to say a few more things about immigration. I am not a soft touch on that matter. I am extremely concerned about the continued underperformance of the UK Border Agency. About six years ago, I made the decision not to deal with immigration cases in my surgeries; I have enough problems from my own electorate to deal with, without having to take up UKBA’s case load as an unpaid officer.
	Although our immigration system is improving, it still has a long way to go. It is simply not right that some people in this country should have to wait seven, eight or nine years for a decision on whether they can stay here. That is inhumane—it does not serve them or the taxpayer well. Unfortunately, those people are egged on by fairly ruthless and unpleasant lawyers, who keep lodging appeals and dragging out the process. However, it is we as politicians, of course, who provide the scope and room for those people to pursue those endless appeals processes. We must truncate the appeals process.

Robin Walker: I congratulate my hon. Friend on his excellent speech. Does he agree that a system that does not work and leaves people in limbo is neither efficient nor compassionate?

Charles Walker: I completely agree. Such a system is not efficient or compassionate and does not carry the confidence of the British people. More needs to be done to ensure that our immigration system carries the confidence of the British people, is fair and rewards immigrants who play by the rules. There has to be a premium for playing by the rules. We have to do something about the immigration system; we have to truncate the appeals process and to deal with people more quickly, including removing them more quickly once a decision has been reached.
	I conclude with a few thoughts. I am a great fan of culture; I have travelled the world and immensely enjoyed other people’s cultures. However, I am also a great fan of our culture, which I think is pretty special—indeed, its promotion and protection are probably why most of us have chosen a vocation in politics. Our culture is often caricatured as being about the royal family and maypoles. Those are important—well, the royal family are; I am not so sure about maypoles—but what is our culture? Our culture, which we should promote ruthlessly, is freedom of speech, freedom of association, freedom of thought and expression, and the rights, protection and promotion of women and minorities. That is what being British is all about and what makes this country so attractive to so many people around the world.
	I want to say something that I hope will not be misinterpreted. If people want to come here and make a positive contribution, that is fantastic. But people coming to this country should please value and respect everything that it offers them. It really is a great place. We can celebrate other people’s cultures, but we cannot have separate communities and societies in this country—that is not healthy for us or for those wanting to live here who eventually, I would like to think, integrate and become part of what is still a great place to live.
	I am afraid I am running out of time, which probably comes as a great relief to most Members. I would just say that I am a world-expert moaner; if the Prime Minister even thinks about me, it is, “Oh my Lord! There goes Charles Walker moaning away again—the moaner-in-chief.” Actually, however, we are not in a bad place in the United Kingdom. Look at what is going on in Italy, Spain, Greece and Ireland. Things are pretty good here. I am sorry to say this to my Liberal Democrat hon. Friend, the Minister of State, Department of Health, but I am the first to whinge about the coalition. However, we are not actually in a bad place and in the final analysis, we should be grateful for what we have.

Barbara Keeley: I welcome the fact that we have a Care Bill to debate. I pay tribute to the hard work of colleagues on the Joint Committee on the draft Care and Support Bill. I also welcome the fact that the Government have taken on board a number of the Committee’s recommendations. However, some have not been adopted. I want to speak about the areas where the Bill could be improved and strengthened: the identification of carers and, as the right hon. Member for Sutton and Cheam (Paul Burstow) mentioned, the clauses relating to young carers.

Roberta Blackman-Woods: Does my hon. Friend agree with the National Young Carers Coalition, which has written to all Members pointing out that the Bill does not do enough for young carers and needs to be amended so that there is a greater responsibility for identifying young carers? Does she agree that the Government should have taken heed of her excellent private Member’s Bill and incorporated it into the draft Bill?

Barbara Keeley: I am absolutely bound to agree with that point, and I will come on to it shortly.
	As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.
	The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.
	When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.
	I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

Madeleine Moon: Last week, I had a telephone call from a young man who is caring for his father. His father has the same condition as my husband, and he contacted me because of the debate we had on dementia. He told me that he had phoned his social services department twice and the psychiatric nurse twice to ask for help and support. He did not know where to turn. Is this not increasingly the problem? There is just no money: no money to provide the assessments and no money to provide the care if those assessments are carried out.

Barbara Keeley: I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.
	In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

Paul Burstow: The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

Barbara Keeley: Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.
	One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.
	That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.
	My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers
	services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

Norman Lamb: I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

Barbara Keeley: Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.
	The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?
	I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

Edward Leigh: I represent a Lincolnshire seat. I wish to say a bit about opinion in Lincolnshire and relay it to the House, if Members are not already aware of it from the local election results.
	Coincidentally, today is the feast day of St Earconwald, who was born in 693 in Lindsey, north Lincolnshire. Various miracles were attributed to him. For example, when he was elderly and in his wheelchair, the wheels fell off but it kept going. I am reminded of how the coalition still keeps going, despite its wheels occasionally
	falling off. I think we may come to a time before the end of this Parliament when, such is the divergence of opinion—perfectly honourably felt—between very honourable people such as the Minister on the Front Bench and me, that for the sake of the nation we may have to bring this coalition to an end and honestly put our separate programmes to the people.

Chris Ruane: When?

Edward Leigh: I have no idea when that will happen.
	I said I wanted to talk about opinion in Lincolnshire. Despite all the Government’s success in their central aim of attempting to cut the deficit—we have cut it by a third—people there undoubtedly feel that their voice is not being heard. We have to listen to that voice. If I may be forgiven for being party political for a moment, I should point out that there is absolutely no enthusiasm for the Labour party, because people have not forgotten who created the borrowing mess we are in. We heard a lot about plain packaging from the right hon. Member for Leigh (Andy Burnham), who led for the Opposition today, but the whole Labour party is plain packaged. We have no idea, frankly, what it will do.

Barbara Keeley: I cannot speak for all parts of the country, but I campaigned in the recent county elections in Lancashire and there was huge enthusiasm for the Labour party.

Edward Leigh: We will have to see what happens in various parts of the country.
	It is said that this is a thin Queen’s Speech. As a Conservative, I do not object to a thin Queen’s Speech. I do not object to deleting unnecessary legislation either, whether on minimal alcohol pricing or plain packaging. I view all these as creatures of the nanny state, so it is good conservatism that we are not introducing them. However, if we are to have a Queen’s Speech that is, shall we say, somewhat light and has lots of room in it, that means there are various other things that we could do. One thing we do not need to do, I would have thought, is persevere with the Marriage (Same Sex Couples) Bill. I will not repeat all the arguments, but this is an area where many people in Lincolnshire feel that their opinions are being not represented.
	If anybody wants to look at an excellent article on this subject, they should read Charles Moore’s in The Daily Telegraph on Saturday. There is a real problem. We are trying to deal with an economic crisis and the very first thing we will do after this Queen’s Speech debate—although it was not mentioned in it; as far as the Government are concerned, this is the Bill that dare not speak its name—is have two days on same-sex marriage. The Bill will then go to the House of Lords. There are enormous, complex issues at stake for the Church of England. I have no doubt that we are moving to a world in which the Church of England will be allowed to conduct only religious marriages, but will not be able to complete them. They will have to be completed by the state because of equality legislation. These are serious issues. The Government could easily mend fences with many of their supporters by putting the Bill out to further consultation.

Stephen McCabe: If the coalition survives longer than the hon. Gentleman suggests, does he think that next time round it might be an idea for the Government to have a debate and then produce a Queen’s Speech, rather than producing a Queen’s Speech and then having a debate about what should not be in it?

Edward Leigh: That is an interesting argument. I have appended my name to the important amendment to the Queen’s Speech, and we should have a serious debate on the issue. This is not Conservative Members of Parliament obsessing about Europe; this is a real issue for people. It is no longer a dry as dust issue.
	In Boston, a seat with a 12,000 Conservative majority, UKIP won nearly every council seat two weeks ago. Unlike my hon. Friend the Member for Stone (Mr Cash), the people there are not particularly worried about all the details of European legislation, but they are worried about immigration. I echo what my hon. Friend the Member for Broxbourne (Mr Walker) said in his very measured speech: people in Lincolnshire are not closet racists. They welcome Polish, Lithuanian and Latvian people, but they want their public services to be supported, when, on the coast of Lincolnshire, public services are overwhelmed. Since 2004, 1.1 million have arrived in this country from eastern Europe, and we have to address that issue.

Anne Main: Will my hon. Friend give way?

Edward Leigh: I am sorry; I have only a short time left.
	Speaking personally as a comfortable, middle-class person living in the hinterland of the beautiful Lincolnshire wolds—where, incidentally, we held all the seats we were defending—and in a comfortable part of London, I have no angst about Poles. They are hard working, and I think that most of them will go back. Their religion is estimable, and I have no complaint whatever against them. But we should listen to the people who are worried about public services, and this is therefore a European issue.
	I personally believe that we should listen to those people and that we should have a referendum. I would also say to my right hon. Friend the Member for Mid Sussex (Nicholas Soames) that I believe that the Prime Minister is absolutely a man of honour and a gentleman, and there is no doubt in my mind that if he is still Prime Minister in 2017 we will have that referendum. The trouble is that ordinary people—if I may use that expression—do not think like us. They do not think in terms of four-year Parliaments; they think about now. The question they ask is, “If this is such an important issue, why can’t we have a referendum in the next two years?”
	There should at least be a mandate referendum that we can put to the British people, asking whether we should have a new relationship with Europe based on political co-operation and economic free trade. If we fail to listen to the people, we will create a sense of alienation and, despite all our success in driving through the Government’s central economic policies and tackling the deficit—the reason that the coalition was created and what we are really about—that would eat away at
	the support for the coalition. A sense of alienation is created when people are worried about their public services.
	People are worried about other issues as well. In the middle of my constituency, the Government are erecting wind turbines more than 150 metres high—taller than the highest point in the Lincolnshire wolds—that are being paid for by ordinary people living in terraced houses in Gainsborough. They are paying £100 a year, and the money is going straight into the pockets of rich farmers, all in the name of dealing with global warming—if indeed there is global warming, if indeed carbon emissions are causing it and if indeed wind farms will make any difference. That all adds to people’s sense of alienation.
	People also worry about the budget for international development. I am personally in favour of spending money on international development, but we have a commitment to spend 0.7% of our gross national product, for which there is no scientific basis. As we reduce the number of staff in the Department for International Development, we are loading more burdens on the remaining staff to hand out more money. That is simply not good economics. It is not a good way to run a Department.
	I do not believe we should ring-fence the budget of any Department. We should spend wisely and carefully on the right things at the right time. Whether we are talking about same-sex marriage, about the EU referendum or about the DFID budget, we must recognise that people are feeling a sense of alienation, and that good, strong Conservative voters do not feel that their Government are representing them all the time. Let us also put the focus on the Labour party, but let us concentrate on the core issue of getting rid of the deficit. Let us make that the successful mission of this Parliament.

Valerie Vaz: It is a pleasure to follow the hon. Member for Gainsborough (Mr Leigh) and to speak in the debate on the Gracious Speech to both Houses of Parliament.
	I do not know about you, Madam Deputy Speaker, but I sense some confusion or dysfunction in the air—it started with the weather: first, we thought it was spring, and then found that it was not—which seems to have got down to the Government. Let me provide some examples. The Government want us to build more conservatories, but at the same time they are asking people to downsize to other properties. Over lunches, they are giving the benefit of the doubt to some companies minimising their tax bills, yet are not giving the benefit of the doubt to those who have to turn up to Atos assessments—even though they are in a wheelchair or have other long-term conditions. That is very dysfunctional.
	Mr Qatada has been given £500,000 in legal aid, when he could have fought his appeal from abroad, but, with the cuts in legal aid, my constituent, Mrs Pressdee, cannot find a legal aid lawyer to help her from losing her home. What about the statement that Eton produces people who dominate Government because of their commitment to public service? I always thought there was a link between Eton and the Labour party, the Woodcraft Folk, the girl guides and the boy scouts, which are all committed to public service. Curiously,
	however, the number of public sector workers, who have a commitment to public service, has been decreasing over the last 13 quarters.
	Let us deal with the commitment in the Gracious Speech to the reform of long-term care. This can be achieved only on the back of moving money from the health budget to social care, which the previous Secretary of State for Health had already started to do. This commitment in the Gracious Speech has been made against the backdrop of nurses and junior doctors saying they need more staff and that they are overstretched, but there is no commitment to staffing ratios.
	About £10 million was spent on the Francis report, but its recommendations on the health service they have been practically discarded by this Government. Instead, the Secretary of State for Health is suggesting what can be described only as a vanity policy—he wants a chief inspector of hospitals. He was unable to tell me how much the chief inspector would earn, where the budget was coming from, whether this counted as committed spending, whether the Treasury knew about it, or whether it was to be taken out of the Care Quality Commission budget. This was not a recommendation that either Robert Francis or the Health Select Committee made. The Health Service Journalsurveyed senior people in the hospital sector, 73% of whom said they did not believe hospital inspectors would be effective. This is a headline vanity policy.
	The Francis report was not about sticks or the smack of firm government, but about a change in culture. Francis said that there should be one organisation undertaking the monitoring of organisations’ ability to deliver compliance of fundamental standards. At the moment, we have the CQC, Monitor and now the chief inspector who will apparently have the power to close hospitals. The Secretary of State made a comparison with Ofsted earlier, so let us remember Helen Mann, a head teacher who was so terrified of an Ofsted inspection downgrading her school from outstanding that she hanged herself. Is this what we want our public servants to do? In any case, it was not Ofsted, but the hard work of teachers and pupils that drove up standards. Here is the chaotic part: for a top-performing hospital, there will be lower regulation. How can that be fair? The Secretary of State was unable to tell the Select Committee how long these top-performing hospitals would be able to keep their top rating? That is a recipe for chaos. And what will be monitored? Again, the Secretary of State was unable to say. Will it be mortality rates, success in surgery or what?
	I would like draw hon. Members’ attention to an article by Professor Nick Black in The Lancet in March 2012, in which he discusses the myth that grew up—that productivity in the NHS was falling—and warned of the dangers of using one set of indicators. That is exactly what happened at the Leeds hospital. The Secretary of State has conceded that the data were not verified when Sir Bruce Keogh made the decision to close children’s heart surgery, leaving parents and professionals confused and anxious. Whoever has the ear of the chief inspector and has their own data could therefore damage a hospital.
	Let me deal now with Gracious Speech’s reference to improving the water industry. Members may like to know that Thames Water, which is controlled by an Australian bank, now proposes to recycle sewage water
	for drinking, yet fails to mention investment in infrastructure or the leaking pipes that caused the shortage in the first place. All that was despite the fact that the company had made £552 million in profit by the end of March 2013. I ask the Government to look further into that.
	This Gracious Speech should be based on justice, tolerance and the rule of law, yet all that is being undermined. The gracious people of this country, on whose behalf the Gracious Speech was made, deserve better.

Nadine Dorries: My speech will be in two halves. I shall talk first about health care issues, as this is a health debate.
	I welcome the Care Bill, particularly its commitment to social care. I feel that words such as “compassion” are sometimes missing from our discussions on health care. Before I say more, let me welcome publicly, for the first time, the right hon. Member for Cynon Valley (Ann Clwyd) to her position as head of a review body that will examine NHS complaints.
	As many Members know, I was a nurse in a former life, and it was a profession that I absolutely loved. I was, I think, a committed nurse. I lived in a nursing home, and often worked for more hours than I was supposed to. I would go into the hospital on my days off to visit patients who had no relatives. I was not alone in that; most of the nurses in my nursing home behaved in the same manner. I pay tribute to a nurse who started work on the same day as me, on 5 November 1975: Helen Windsor, who contacted me recently. For all these years, she has been delivering the same committed care that she delivered in 1975.
	I suppose many people will say that that was a long time ago, and it was, but I think that qualities such as compassion, kindness and caring are timeless. It does not matter when they were being delivered; they should be delivered in the same way today. Unfortunately, however, I—like many other Members—regularly receive complaints from constituents about the standard of nursing care. I mentioned Helen Windsor because I want to pay tribute to the nurses who do deliver good care.
	I recently visited a constituent in hospital, an 89-year-old man with no relatives. It was interesting that the right hon. Member for Cynon Valley mentioned nail clippings, because I had already written down that I intended to raise the subject. That constituent was agitated because his nails were serrated and were catching on the cardigan that he was wearing as he sat in his chair. When I asked the nurse whether she could cut his nails—he said that he had been asking for it to be done himself—she replied “No, I can’t. We are not allowed to do that.” So I took an emery board out of my handbag and filed his nails myself. I know that sometimes, as Members of Parliament, we feel that we are social workers, but I had never imagined that I would extend my role to the nail care and general hand hygiene of a constituent in hospital—but I did.
	Unfortunately, on a number of occasions recently I have sat in a hospital and witnessed nursing care being delivered to my own daughter. Only a few weeks ago, when she was on a hospital trolley waiting to go into the operating theatre—distressed, anxious, upset—we witnessed nurses holding conversations over her head about intimate
	details of their love lives and their social lives, which, while she was in pain, my daughter had no interest in hearing. Not only was she subjected to those intimate details of their private lives; she was also subjected to a lack of care. She was completely ignored on that trolley. Yes, she was about to go into an operating theatre and be dealt with, but it is when patients are in that condition that they need nursing care most. They need to be reassured. They need to be calm. They need to know that everything is going to be OK. However, there was no interest in that.
	The most appalling thing that happened was that, just before my daughter went into the operating theatre, one nurse told the other that she was going to the bathroom, and then gave exact details of what she was going to do there. I cannot think of a more polite way of putting it in the Chamber. It was a totally inappropriate conversation to be having outside the doors of an operating theatre.
	A constituent who recently came to see me in my surgery told me that, when in hospital following a road traffic accident, she had noticed after a few days that her bottom sheet had not been changed and was bloodstained. Each day she wrote the date around the border of the bloodstains. When she left hospital 10 days later, she left that bottom sheet for the nurses to see, with the dates written in a pattern around the bloodstains. During those 10 days, no sheets had been changed. We used to change the sheets every day, and that was possibly excessive, but I think that, given that we are constantly trying to find ways in which to deal with, beat and get on top of hospital-acquired infections, bloodstained sheets indicate a lack of care.
	I do not want to labour the point about complaints, because I know that a number of other people have already done so, and I feel that it is now the remit of the right hon. Member for Cynon Valley. Rather, I want to discuss immigration and its impact. We send £53 million per day to Europe, which limits our dealings with the rest of the world—in fact, the Prime Minister is trying to tackle that issue today. Labour will not commit to a referendum. Do Labour Members not see that that £53 million a day could be spent on dementia care, on Alzheimer’s care, on young carers? There are so many things we could do with that money.
	People were asked one question when we went into the Common Market: do you want to go in, yes or no? They should be asked the same question to exit. If we can go to the electorate on behalf of the Liberal Democrats with a referendum on the alternative vote in a matter of months, why do we have to wait years to offer them a referendum on an issue as big as the European Union? Do we not realise what a self-serving, self-interested bunch we seem to people out there, when we can call an expensive national referendum on AV, yet obfuscate and delay on the question of European Union membership?
	It is no good saying that people are not interested in this issue, because they are: it is the subject of almost every other question I am asked when I go out in my constituency. People now know exactly how much we are spending on the European Union, and they do not believe that leaving will cost us 3 million jobs. They would like a piece of the action in China, which reported growth of some 9.5% in the past year. They want some of the action taking place in the BRIC countries. That is where they want to trade—not in a sick and failing Europe that is getting sicker by the day.
	I want to add my voice to those who have spoken out on this issue, and I would definitely join the two Cabinet Ministers in voting to be out. I would vote no tomorrow, and I know many of my constituents would. I completely support the measures in the health Bill in the Queen’s Speech, which will be well received by everybody, but I want to add my voice to the case for an in/out referendum. We must find a way to deliver that. We know that the Prime Minister means what he says; but if we can do it on AV, we have to do it on the EU: otherwise, people will not believe us.

Kevin Barron: I have to say to the hon. Member for Mid Bedfordshire (Nadine Dorries): welcome back to the Conservative party. I heard what she has been saying today from the Conservatives about 20 years ago. It led to their spending 13 years in opposition, and I hope it has the same result in a couple of years’ time. I look forward to that.
	This debate seems to be more about what is not in the Queen’s Speech than what is, but immigration and access to the national health service are addressed, and I have to say that the tone of this debate has been quite distasteful. We know that, from time to time, some of our constituents go to work in other European economic area countries; they pay their taxes and social insurance contributions there, and as a consequence they are allowed to obtain health care in those countries. Immigrants are not coming to this country to use our national health service, and they do not use it for free: they pay, as they should.
	We need be very careful when we talk about people moving around Europe. Tens of thousands of our fellow citizens have gone to live in Spain, Portugal and France, not to work but to retire. If they return to this country en bloc, consider the impact on the health service, social care and care for the elderly. We need to have a rational debate on this issue.

Anne Main: In the last Parliament, I was privileged to serve on the Communities and Local Government Committee. We produced a report on community cohesion and integration under the right hon. Gentleman’s Government. It said that the pace of change, the resources and facilities were all wrong, and many of the communities we visited said that. He needs to show a little humility when talking about immigration and numbers, because his own Government condemned the situation in that report.

Kevin Barron: It was not a Government report but a Select Committee report, and I do not remember it, quite frankly.
	Community cohesion is important and has been important in this country for centuries—not just since we joined the European economic area or the EU expanded to 27 countries, with people having the right to come and work here, as indeed we have the right to go out and work in other EEA countries. A lot of this debate is distasteful and is not the truth. In a recent by-election, a political party that is not represented here and I hope will not be was saying that, as of January next year, probably nearly half the population of Bulgaria will
	come and work in this country. That is nonsense, and neither Back Benchers nor Front Benchers should have a knee-jerk reaction to that type of debate. We should have sensible debates about what immigration does or does not do in this country.

Nadine Dorries: Can the right hon. Gentleman provide evidence for his numbers? Can he tell us how he knows what the numbers will be? Can he quote from some extensive research that proves this?

Kevin Barron: I was quoting from the rhetoric put into the daily press during the Eastleigh by-election. I think the figure given was that about 3 million Bulgarians will be coming to this country—

Nadine Dorries: How does the right hon. Gentleman know that that is not the figure?

Kevin Barron: If the hon. Lady will keep quiet, I can tell her that that was what was said, but there are fewer than 8 million Bulgarians living out there. Many Bulgarians have been living and working in this country for many years, because they met criteria outwith the criteria laid down when Bulgaria and Romania joined the EU. The whole debate is disgraceful, and we should get it into some perspective.

Gerald Howarth: Will the right hon. Gentleman give way?

Kevin Barron: No, I have given way twice and I am not going to give way any more.
	What is not in the Queen’s Speech? Public health has been mentioned by several people. I served on the Bill Committee for what became the Health and Social Care Act 2012. I will leave the reorganisation of the NHS for another day, but at the time the Bill was going through, the defence given by Ministers was, “What we will start doing is putting real measures down, and for the first time ever we will put in statute a responsibility to reduce health inequalities in this country.”
	Two policies that most people involved in and concerned about public health thought would be in the Queen’s Speech are absent. One is the minimum pricing of alcohol, which was talked up by the Prime Minister over many months. There is evidence that it will stop some people drinking excessively. I served on the Health Committee in the previous Parliament, and just before the general election we published a report on alcohol. People ought to read it to see exactly what is happening. One of the worst statistics was on the people who are likely to die from alcohol-related diseases—certainly cirrhosis of the liver. Thirty years ago, they were people like me—men in their 60s—but now, men and women in their 20s are dying of that disease. This House has a responsibility to do something about that.
	The other area that I wish to discuss briefly is the absence of legislation to bring in standardised packaging of cigarettes. That has also been talked up, not only by the Prime Minister but by others. The consultation on standardised packaging started on 16 April last year and ended on 20 August; now, nine months later, nothing is going to happen. I am deeply concerned, and I will tell Members why, although there can be no surprises about me and tobacco, because I have been on an
	anti-tobacco crusade in the House for nearly two decades. In my borough—I represent a third of it—there are still some 48,000 smokers, and although the number is declining, it is likely that more than 950 young people between the ages of 11 and 15 will take up smoking this year, and half of them will die a premature death. This year, more than 100,000 of our fellow citizens will die a premature death from using tobacco as instructed to by the tobacco companies. If half that many people were dying of anything else in this country, this House would be up in arms about such a massive number of deaths. In the past few months, what we have had is Ministers talking up the idea of legislation further to protect young children from starting smoking, but none of that has come about.

Paul Burstow: When the right hon. Gentleman chaired the Health Committee, it published the report that led to the banning of smoking in enclosed public places. That ban was only secured by a free vote in this House. Does he agree that, if we cannot get the Government to act, we need a free vote so that we can make the change in that way?

Kevin Barron: I shall be putting my name in the ballot for a private Member’s Bill in a few days. If I am successful as I was in 1993, the right hon. Gentleman will have a Bill on standardised packaging on which to vote.
	The Government have ducked the issue. There has been some influence—many people say that Lynton Crosby, who has come along to advise the Government, has had that influence, but I will not make that accusation. I wrote to the Prime Minister last week to ask several questions about whether Lynton Crosby has been involved in giving any advice in political circles in this country. Lynton Crosby is advising the Conservative party about re-election, but I want to know whether he has been involved in this area, given his record both politically with the party that he ran, and with his company’s work with and the money it has taken from tobacco companies.
	The right hon. Member for Sutton and Cheam (Paul Burstow) is quite right to say that in 2006, when this House took a decision on smoking in public places, Members of this House had a free vote. I was effectively the architect of that free vote, because I tabled an amendment signed by 10 members of the Health Committee and I negotiated a free vote with my own party, as one was being offered by the then Opposition. On that major public health measure, this House was trusted to take the decision itself. Yes, we were lobbied by our constituents. There is nothing wrong with that—after all, it is what we are here for, although we cannot represent them all, as some people seem to think we can. The House was trusted to make that decision and the then Government, to their credit—they should have been awarded that credit—allowed it to do so. Many people were against that, including the Prime Minister, who has said since that he thinks it is the best piece of legislation that ever went through this House.
	I say to Ministers that, whether it is because of strings being pulled by people close to the tobacco lobby or because of anything else, we cannot tolerate their not taking further action against tobacco when it is killing 100,000 of our fellow citizens each year. It is about time that someone showed some courage, stood
	up for ordinary people and for good public health measures—not nonsense measures—and did something to stop the dreadful premature deaths in this country.

Gerald Howarth: I must say at the outset that I am disappointed that no day has been set aside for us specifically to discuss defence and foreign affairs, because we face some pretty severe challenges around the world and, of course, our armed forces are undergoing major change. Such a debate would have provided me with a further opportunity to argue that we should not spend another £2.5 billion on overseas aid this year and that we should divert that money to our armed forces, which are very hard-pressed.

James Duddridge: I understand my hon. Friend’s argument, but I disagree with it. I respectfully ask him: what is the right amount to spend on international aid?

Gerald Howarth: It is a question of priorities. Our level of aid is such that the Prime Minister can say, with great justification, that Britain has given a lead in the world, but the figure of 0.7% is entirely arbitrary. I would submit that there is no natural level for the amount of aid to be given. I am not an opponent of overseas aid; I just believe that there should be other priorities at the moment.
	I do not wish my speech to be a negative one, and it was written not by Mr Lynton Crosby but by myself. I welcome some aspects of the Gracious Speech. The first is the continuing priority to cut the budget deficit. It was pretty nauseating to listen to the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), and to hear him demand more money here, there and everywhere. He was part of a Government who destroyed the public finances of this country. That is why we have to make cuts. These cuts are Labour’s cuts across the country, because Labour destroyed the public finances by running up an impossible debt.
	Secondly, I welcome the confirmation that we are going to pursue further reforms of the benefits system. It has been most encouraging to see how warmly the country has received our changes, particularly the £26,000 limit on families receiving benefits. The Philpott case was an eye-opener to many, highlighting that far too many people in this country are living a wholly immoral lifestyle on public finance, and we need to crack down on that.

Kevin Barron: Will the hon. Gentleman give way?

Gerald Howarth: As the right hon. Gentleman would not give way to me, I am rather disinclined to give way to him.

Kevin Barron: Will the hon. Gentleman give way?

Gerald Howarth: I will come back to the right hon. Gentleman in a minute.
	Thirdly, I welcome the further attempts to bear down on regulation. We need to do much more to liberate businesses from regulation, but we are, of course, inhibited by Europe, on which I wish to say a few words later.
	Fourthly, the reform of long-term care arrangements has not come before time. I recommend to my Front-Bench colleagues an excellent publication from March 1997 called “A New Partnership for Care in Old Age.” We had a tremendous scheme then, which unfortunately we were not able to implement because power passed to Labour, whose Government did nothing in the 13 years when they had stewardship of these matters. I also welcome the measures to tackle immigration, although I suspect they will have limited effect.
	Finally on the good news front, I think the Prime Minister has done a fantastic job of promoting Britain’s interests overseas, particularly in developing overseas trade. We have seen some reflection of that in increased trade with non-EU countries, as against trade with the EU, which, as we all know, is in meltdown.
	Two issues were not mentioned: gay marriage and Europe. My hon. Friend the Member for Gainsborough (Mr Leigh) set out why the same-sex marriages proposal is a complete diversion. We should not be doing this: the Government have no mandate for it, it is deeply divisive, particularly among many Conservative supporters, and I think we should drop it here and now.
	Immigration is a big issue and it is relevant to this debate, as the Government are seeking to put in place changes to prevent people from benefiting from our taxpayers’ money by coming to this county simply to tap into our health care system. There have been encouraging signs. The observations made by the right hon. Member for Rother Valley (Mr Barron) show precisely what has been wrong in this country, in that anybody wishing to speak up on immigration has been told that their tone is wrong, or this is not the right time, or they are insensitive. His Front-Bench colleagues have now recognised that the kinds of policy he supports have been deeply damaging to his party. Labour supporters are as concerned about immigration as Conservative supporters and, I suspect, Liberal Democrat supporters.

Stewart Jackson: My hon. Friend is making a powerful case. Does he agree that we should take the blandishments of the right hon. Member for Rother Valley (Mr Barron) in respect of Romania and Bulgaria with a pinch of salt, given that the Labour Government predicted that between 13,000 and 15,000 eastern European citizens would come to the UK, yet over 1.2 million have come here since 2004? Labour got the figures catastrophically wrong.

Gerald Howarth: My hon. Friend is absolutely right. I was going to tell the right hon. Gentleman that some 1% of the Romanian population of working age, which is 150,000 people, have indicated that they wish to come to this country, as have 4% of the 4.9 million Bulgarians of working age, which is another 200,000 people. That is another 350,000 people. We cannot go on building houses and cities. As MigrationWatch has said, we will need eight cities the size of Birmingham if we are going to accommodate all the people who wish to come to this country.
	I welcome the fact that the Opposition have at long last recognised that this is a serious issue. They have not a snowball’s chance in hell of being re-elected unless they are prepared to recognise the concerns of the
	British people. Under Labour’s stewardship, there was a deliberate act of policy: Andrew Neather, a speech writer at No. 10, said immigration was being positively encouraged by the Labour Government in order to
	“rub the Right’s nose in diversity.”
	They knowingly inflicted this on the country—it was not done by accident—and they left this Government with the most awful backlog of cases to deal with, which is unfair to those who ought to be allowed to stay in the UK and to those in our country whose lives are affected by the presence here of people who should have been deported.

Anne Main: The Select Committee report “Community Cohesion and Migration”, which Labour Members seem to have forgotten about, stressed that second and third-generation immigrants were as resentful as the native British population, because the necessary resources were never provided by the Government, who encouraged so much immigration so fast and without preparation.

Gerald Howarth: My hon. Friend is absolutely right. Immigration is imposing burdens on our services, such as the health service and social services. I am seeing that in my own constituency. We now have some 10,000 Nepalese, mostly elderly, who have come to the United Kingdom as a result of the politicians’ caving in to the campaign run by an actress called Joanna Lumley. That has resulted in a fundamental change to the nature of Aldershot that has deeply upset my constituents, who are entitled to express a view without being told that they are racist. They do not like seeing their locality changed—[Interruption] I wish the right hon. Member for Rother Valley would shut up—because of something on which they were not asked for their opinion. When they do express an opinion, they are dismissed as being racist.
	The projection that the United Kingdom’s population is likely to reach 70 million in the next 15 years means, as I said, that we will need to build eight large cities outside the capital during that time—in other words, one home every seven minutes, day and night, just to house new immigrants unless the Government are able to continue their progress in tackling immigration. The 2011 census revealed a mass exodus of white British from the city of London—a fall of 600,000 between 2001 and 2011. Almost half the population of Ealing and Hammersmith were born outside the United Kingdom. These are fundamental changes to the nature of our country. The people of Britain are entitled to express a view on the composition of their country. Last week there was a story in the Evening Standard about Harris Primary Academy Philip Lane in Haringey, where 59% of the 463 children are on free school meals, 79% have English as a second language, and Somali and Turkish are the most prevalent languages. What are we doing to our country? We have to take sterner action, and I recommend that to the Government.
	Let me turn briefly to Europe, which the right hon. Member for Leigh dismissed as irrelevant and not a great issue that should be addressed, although he had no answer to the challenge by my hon. Friend the Member for Gainsborough. This issue is not going to go away, and it is of great concern to people in this country. Our European partners are determined to create a united states of Europe, which is not what the people
	of Britain want. The Prime Minister is entirely right to seek to renegotiate. He is also right to have a referendum. Like my right hon. Friend the Member for Mid Sussex (Nicholas Soames), I profoundly believe that he will deliver that referendum after the next election. The trouble is that people are uncertain about whether we are committed to that. The way to deliver it is a new Act of Parliament during this Parliament to determine that there will be a referendum during the next Parliament.

Anne McGuire: It is a pleasure to speak in this debate and to follow the hon. Member for Aldershot (Sir Gerald Howarth), although obviously I would not necessarily agree with all his comments.
	I was not going to say anything about immigration, but sometimes we need to look to ourselves when we talk about that subject. I suspect that there is not one individual here who has not had at one point in their background an immigrant who came to the United Kingdom. Those who talk about the “native British” need to reflect on the fact that Britain has always had immigrants—from the Vikings to the Huguenots and from the Dutch to the Irish. My father told me that our family were descended from members of the Spanish armada who were shipwrecked off the north coast of Ireland when they were trying to avoid the English fleet. We need to reflect and have a rational debate about immigration, not the hysteria that there sometimes is in this House.

Madeleine Moon: Will my right hon. Friend give way?

Anne McGuire: Very quickly because I want to get on to the main substance of my speech.

Madeleine Moon: Should we not get some of the figures clear in our heads? According to the Department of Health website, the actual cost to the NHS budget of the amount spent on foreign nationals is a mere 0.06%. This is not something that we cannot afford.

Anne McGuire: As I have said, I do not want to go down that track but, having been nursed in a UK hospital by non-indigenous British staff, I think we ought to be more balanced in our comments on immigration.
	The main focus of this debate—health and social care—is a vital issue for many people; even if they do not think so at present, it certainly will be in the future. As we are all aware, the changing demography and advances in modern medicine and technology have thrown up challenges to our society in how to develop the capacity for social care and, indeed, how to pay for it. The issue is not unique to the United Kingdom; it is a challenge in many countries across the world. As has already been said, the Administrations in Wales and Scotland are developing their own policies in the realm of social care.
	Although the legislation under discussion relates to England specifically, I want to discuss some general issues that cut across the debate in the whole of the UK. Like my colleagues on the Opposition Front Bench, I welcome some aspects of the Care Bill, which builds on the work undertaken by my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, when he was in government. I hope that the Bill will
	simplify the existing regulations, provide some confidence that lifetime assets will not be swept away by care costs, and—I stress that I hope that this will happen—eradicate the postcode lottery of care, introducing an element of consistency to the system. The Bill should also give stronger legal rights to carers—I echo the words of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)—who are often the forgotten players when we debate social care.
	Having said that, there are still some major areas of concern and I want to concentrate on them. Frankly, they throw up challenges for everyone in this House, regardless of which political party we belong to. I am not convinced that the Government have thought through where young carers fit into the big picture painted by the new Bill. It is, of course, a welcome development that, for the first time, councils will have to meet the eligible needs of carers for support. I also welcome the aim for a family assessment, which in some areas should pick up the pressures on young carers.
	Many organisations representing young carers, however, feel that many concerns have not been covered adequately. The well-being of young carers very much depends on the level of support that the person they care for—more often than not their parent—receives. If that support is not adequate, an unacceptable pressure remains on young people who should, to be frank, be doing other things. Council budgets are being stretched and care and support is being restricted in many instances to those who have critical or severe needs, so an unacceptable burden is still being placed on young carers who support family needs but who will not meet the new exacting standards.
	I do not want to reiterate some of the points that other hon. Members have made about the need to move from the current random method of identifying young carers to a more systematic approach. I want to spend a few moments on the issue of working-age people who need support from our social services. Too often the debate on social care concentrates on older people, but it should not focus on them alone, because the reality is that about a third of people who rely on support are of working age and they are often forgotten. I am sure we will all agree that a younger person’s need for support from the care system is not necessarily the same as that of an older person. To that end, the all-party parliamentary groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler), as chair of the local government APPG, and Baroness Campbell of Surbiton and myself, as joint chairs of the disability APPG, were delighted that 10 parliamentarians of all parties and from the Cross Benches in the Lords agreed to undertake an independent inquiry.
	The report will be launched officially on Wednesday, so I will not pre-empt its findings. I hope that colleagues will take time out of their schedules to come along and hear what the disabled people, organisations and experts that appeared before the inquiry committee said. The evidence is powerful and I hope that people will read it. When we debate health and social care over the next few weeks, I hope that we will listen to the voices of the people who matter: the people on the receiving end of the system. What they say gives us food for thought and food for action.
	It is well documented that more than a third of the people who receive social care are of working age. We must also recognise that most of the pressure and innovation will be at a local level. It is important that we encourage local organisations and local government to ensure that there is innovation in the system. As my right hon. Friend the Member for Leigh said in his opening remarks, there is a funding crisis in local government that no amount of innovation can mitigate. There is only so much innovation that any system can support without the recognition of financial instability. It is not just Labour councils that are saying that to the Government; councils of all political persuasions are trying to persuade the Government that they cannot continue to support the pressure that is being placed on their social services.
	Finally, we have spoken a lot about the cap and the protection of assets. The Government have not been clear about what will happen to people who do not have the capacity to build up assets, and I am talking about working-age adults who are disabled who have not had that opportunity. The overwhelming majority of people with learning disabilities will not be affected by a cap because they do not have an asset base to protect.
	I hope that there will be a robust, challenging and honest debate about the future of social care.

Pauline Latham: It is a pleasure to speak in the health and social care debate on the Queen’s Speech, which seems to have been rather wide-ranging.
	I pay tribute to the Government for introducing the Care Bill. It shows that they have listened to the concerns of many people. I support the proposals for three main reasons. First, the Bill will put people in control of their care and give them greater choice. Secondly, it will simplify the system and processes to provide the freedom and flexibility that local authorities and social workers need to innovate and achieve better results. Thirdly, it will provide people with a better understanding of what is on offer, help them to plan for the future, and ensure that they know where to go for help when they need it.
	The Care Bill is essential to the modernisation of adult care and support in England. One purpose of the Bill is to set out clearly what support people can expect from the Government and what action the Government will take to help them to plan, prepare and make informed choices about their care. I support the well-being principle as an underlying principle for care and the support for carers. However, I urge colleagues in the Department of Health to monitor the implementation of the Bill carefully to ensure that local authorities are completely clear about their responsibilities.
	I have a constituent who suffers from an acquired brain injury. His parents sought assistance from the adult care services department of their local authority, Derby city council, and from the primary care trust. Both organisations say that it is the other’s responsibility. That is causing great distress and frustration to my constituent’s elderly parents who are caring for him and his six-year-old child. I have written to both parties, as well as to Ministers in the Department of Health, and so far both have repeatedly refused to take responsibility.
	I have also written to Health Ministers about another constituency case. A constituent of mine is suffering from severe chronic pancreatitis and has been told he needs to undergo a pancreatectomy and an islet cell transplant. However, as the national specialised commissioning group has not issued confirmation of funding for an islet cell laboratory in my region, my constituent is left suffering in extreme pain unnecessarily. I would like to see movement on the two cases that I have raised with the Department of Health.
	Over the past three years, I have also raised constituency casework concerning the cancer drugs fund, and I pay tribute to my right hon. Friend the Prime Minister who set up that initiative. Some 23,000 cancer patients in England have benefited from the additional £650 million pounds provided by the Government to fund cancer drugs.

Mel Stride: Like my hon. Friend, I welcome the cancer drugs fund, which I think is important. About 150 of my constituents will die from cancer this year—about 100,000 people a year. Currently, 15% of 15-year-olds are regular smokers. Does my hon. Friend feel, as I do, that we should have standardised plain packaging of cigarettes to discourage the take-up of smoking and the cancer that results from it?

Pauline Latham: I certainly do, and having watched my mother die from lung cancer, I passionately believe in anything that will stop people smoking. It is not a pretty sight, and I would do anything to stop young people in particular taking up the drug of smoking. That is important.

Gerald Howarth: I am grateful to my hon. Friend for giving way. Our hon. Friend the Member for Thurrock (Jackie Doyle-Price) mentioned the risk from counterfeit tobacco, which is very serious indeed. There are two risks: first that the substance will be less pure than commercial tobacco; and secondly that the Treasury will lose a tremendous amount of money as the result of trafficking.

Pauline Latham: There is already counterfeit tobacco, so I do not see that it would make much difference. Those who are drawn to smoking do not go over and buy counterfeit goods; they start off in this country—often under age—by buying cigarettes over the counter. If we can stop that, I passionately believe we should do so, and I am disappointed that that measure was not in the Queen’s Speech.
	The cancer drugs fund is a force for good, but in my constituency of Mid Derbyshire, which was covered by the east midlands cancer drugs fund, I have had constituents who were unable to access cancer drug treatment that was available from other CDFs. In one case, if my constituent had lived just 40 minutes down the road in Burton upon Trent in the west midlands, that CDF would have paid for her treatment. She paid more than £60,000 of her own money, but since I first raised the issue she has sadly died. The reforms introduced by the Government from 1 April this year and the establishment of the national CDF will end the unfair system of the postcode lottery. Under treatments now offered by the new NHS Commissioning Board, if my constituent were alive today, she would have access to that treatment.

Hugh Bayley: Will the hon. Lady give way?

Pauline Latham: I am running short of time; I am sorry but I must make progress.
	I urge my right hon. and hon. Friends on the Front Benches to look again at this matter because the Government have set up the CDF to ensure that people get access to the life-saving cancer treatment they need. I have constituents who need access to a form of radiotherapy called “SIR-Spheres”, which is used where bowel cancer has spread to the liver. That treatment is not now available anywhere in the NHS—people can pay for it, of course—although it was previously available in most CDF areas, although not the east midlands. Will the Minister look again at the issue and meet me and my constituents’ hospital consultant, Dr Jamie Mills, to see whether we can make progress?
	I recently started working with the British Heart Foundation on sudden adult death syndrome after I was contacted by two constituents whose son, Sam, died suddenly as a result of cardiac arrest. He was 19 years old. SADS claims the lives of at least 12 young people such as Sam every week, but many of those fatalities are completely preventable. I knew a young man in his 20s who died in the middle of his round in a dressage competition. Like Sam, he was a very fit young man. All such young deaths are devastating for everyone concerned, family and friends alike.
	The seconds and minutes after someone has a cardiac arrest are vital to ensuring their survival. Cardiopulmonary resuscitation should be used immediately until a defibrillator can be located. If those activities are used together, the potential for survival is immediately increased. In fact, here in the UK, we currently have only a 20% survival rate—that figure is for all cardiac arrests, not just cardiac arrests among young people—but in Seattle, where there is mandatory CPR education in secondary schools, the survival rate has increased to 54%. I am sorry that my hon. Friend the Under-Secretary of State for Skills in the Department for Education is no longer in the Chamber—he was here a few minutes ago. My suggestion is that, if we roll out a schools programme, we could increase survival rates, as more children are trained to undertake CPR and to follow-up with defibrillators.
	I am deeply concerned about those figures. I should like to highlight the pressing need for the availability of life-saving equipment and skills in our schools. In the first instance, will the Department of Health work with local authorities through health and wellbeing boards to urge them to consider providing funding to install automated external defibrillators in all schools and other local authority facilities? AEDs are very simple to use, even for the untrained layperson. Detailed instructions on how they are to be deployed are delivered through a set of simple audio and visual commands. The machines are programmed to administer an electrical shock only if the patient’s condition requires it. In order to prevent mortality as a result of SADS, it is essential that those easy-to-use and relatively inexpensive devices are made available in schools.
	Further to the availability of AEDs, it is also extremely important that, through citizenship lessons, children of school age are aware of, and able to administer, life-saving treatment such as CPR. Such a scheme would cost local authorities very little, and ultimately has the potential to save many lives every year. Organisations such as
	St John Ambulance would be able to go to schools to train students and teachers so that they are able to undertake such treatment.
	In addition, I should like to point out to hon. Members that the British Heart Foundation provides grants to schools for defibrillators. Many schools are not aware of that. Perhaps MPs on both sides of the House could make schools in our constituencies aware of the grant. I look forward to working with the Department of Health on the issues that about I have raised about the cancer drugs fund and on defibrillators.

Stephen McCabe: It is a pleasure to follow the thoughtful speech of the hon. Member for Mid Derbyshire (Pauline Latham).
	I congratulate the Government on their fine display of unity on the Queen’s Speech. In all my years in the Whips Office, I cannot recall seeing anything quite like it. In the early days of the Government, the ambition was simple: wipe out the deficit in a single Parliament, set debt on a downward path and restore health to the economy. Hon. Members were to judge success by how the credit ratings agencies maintained the triple A rating. Simple! The Government now claim that their ambition is to cut the deficit by a third, but almost everyone else believes it is more likely to be cut by only a quarter. That is our lot for the rest of the Parliament. Debt is rising, not falling, and triple A credit ratings are but a distant memory.
	After the costs in administrative chaos caused by the top-down reorganisation of the health service, which the Prime Minister promised would not happen, the Government are turning their hand to social care. They are right to do so, at least in the sense that social care is a time bomb that desperately needs tackling. My most recent survey of constituents in Selly Oak shows that 73% of them consider care to be an issue of extreme importance, and only 42% think that the quality of care received by someone close to them is satisfactory.
	People are struggling—people such as Mrs Hanslow, who cares for her 96-year-old father. She asks only for the odd break, and in the past she has arranged that by phoning a social worker. When she tried that this February, she discovered that the social worker had left. The office said that somebody would phone her back, but nobody did. She phoned again and was told that she needed to make a fresh application; apparently, files and arrangements leave with the social workers these days.
	After several abortive attempts, Mrs Hanslow spoke to a nice lady called Wendy, who said that she would sort the situation out. Then a Mrs Collins rang saying that she was arranging for a social worker to come. But guess what? Mrs Hanslow waited in all day and no one came. Frustrated, she rang again and spoke to a Jackie, who could find no record of her application or complaint but said that someone would ring her back. No one rang, so Mrs Hanslow phoned again. This time, people at the office were not so nice. Mrs Hanslow was told that nothing had been reported because the social worker was out of the office.

Pauline Latham: What the hon. Gentleman is describing is the fault of the local authority, not the Government. The local authority is responsible for social workers, not the Government.

Stephen McCabe: Bad practice is a problem everywhere, and everyone has to take responsibility for it—that is my point.
	When Mrs Hanslow got upset and said she would have to cancel her break and lose her deposit, she was told, “That’s up to you.” She did not get her respite care. She is now under the care of the GP, and if she cannot carry on, we will need to find a bed for her dad. Perhaps he will become another bed blocker; there are so many in Birmingham that the brand new Queen Elizabeth hospital cannot cope and emergency wards in the old hospital, scheduled for closure, are reopening.
	What about my constituent Margaret McGarry? She has cared for her elderly mother, who now has 9% kidney function and a dementia score of six, for about 10 years; if it was not for Ms McGarry’s love and care, her mum would probably be dead. In 2004, her mum received direct payments from Birmingham, which enabled Ms McGarry to hold down her job as well as look after her.
	The family then moved to Redbridge, but Redbridge decided that Ms McGarry’s mum was Birmingham’s responsibility. Ms McGarry pointed out that she was the carer and that her mum lived with her, but that was not the case as far as Redbridge was concerned. Eventually, the council offered the equivalent of six hours of support, as opposed to the 34 that Birmingham had provided.
	Last year, after a hospital experience that almost killed her mum, the family moved back to Birmingham. Ms McGarry’s mum now needs almost constant care. That means another assessment, which takes weeks and weeks. As soon as they moved, Redbridge council terminated the payments. Birmingham’s assessment commenced in August. In November, it recommended fewer care hours than Redbridge and by December still had not paid a penny. As the old lady’s health deteriorates, so does the level of support.
	I have had a letter from the man in charge assuring me that the case is complex. One of the complexities seems to be that Ms McGarry has exercised her rights and engaged a solicitor. Apparently, that is a very naughty thing to do if a person is caring for an elderly relative because Ms McGarry has now been advised that all direct payments are being stopped. That is the reality of social care in this country today, and it is against such nonsense that we are asked to have faith that the Government are going to give people more rights. We are asked to accept that £150 million and promises from the Secretary of State will fix the problem. It may have escaped the Government’s notice, but the most recent round of cuts took a further £800 million out of services for the elderly and disabled, on top of last year’s cuts. When will it dawn on the public relations boys in No. 10 that it is pointless pretending they are giving people more rights when they are cutting services to the bone?
	Let us examine what the Government are actually doing. They say they are setting a cap at £75,000—£72,000 in the first instance—raising the savings limit to £123,000 and giving a guarantee that no one will have to sell their home. Of course, £75,000 only covers the costs of care, not what is called hotel costs, such as food and accommodation. The cap is not, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out, the amount the individual spends, but the amount a local authority can buy for £75,000. When we add the real costs of residential care, rather than the
	local authority rate, to the hotel charges, it is much more likely that an individual will spend at least double that amount before the cap kicks in.
	The £123,000 savings threshold means that anyone who has capital, including an empty home, will have to pay all their care costs until the cap is reached. That only leaves the guarantee that no one will be forced to sell their home—except that since October 2001 no one has been forced to sell their home. The previous Government introduced the deferred payments scheme and, in 2009, advised local authorities that if they failed to recognise the scheme, the courts would almost certainly rule their actions illegal. No interest is charged on deferred payment arrangements while a person is in receipt of care, or for 56 days after their death. The Government intend to make the existing arrangements compulsory, but also apply interest charges from the moment the scheme is activated. While questions remain about who will qualify, it is estimated that most of the additional subsidy will go to the richest 40% of people in the care system. That is what is wrong with the Government. The Government are built on falsehoods: falsehoods about the unity and purpose of the coalition; denial about the real state of the economy; and policies that are more about UKIP than the UK. We need genuine reform. That is what a decent Government would put in the Queen’s Speech.

Robert Walter: I would like to talk on two issues that, although not included in the Queen’s Speech, will come before the House in this Session, one of which needs to be addressed with some urgency.
	In 2005, the European Court of Human Rights ruled that Britain’s automatic blanket ban on the right of prisoners to exercise their vote was incompatible with the convention on human rights, of which we are a signatory. Almost eight years on, the United Kingdom has still not acted on that ruling and time is running short. The Government must submit their response to the Council of Europe’s Committee of Ministers by 30 September. We have less than five months to prepare and present a formula that will be not only satisfactory to the Committee, but acceptable to Parliament and credible in the eyes of the British public.
	I would like to state from the outset that I disagree with the ECHR ruling. I believe that the current ban on prisoner voting, which was ruled on and reinforced by successive Parliaments, is a proper and proportionate response following conviction and imprisonment, and I spoke and voted accordingly when the House last debated this matter. I repeat that to my mind the right to vote is not an intrinsic right, but a civic duty reserved for responsible citizens. However, we cannot talk of individual duty and responsibility in the eyes of the law while shirking our national obligations to uphold the international rule of law, one of the basic tenets of British foreign policy. And here is the troubling paradox: if, as the old maxim goes, no man is above the law, surely no country is either. I welcome the fact that this Government, unlike their predecessors, have recognised this responsibility, and I am pleased that the draft Bill on prisoner voting has been presented and that a Joint Committee will consider its options, but I am concerned that matters are progressing slowly against a swiftly approaching deadline and that we are not making a strong enough case for a pragmatic solution.
	If the Government choose to maintain the status quo, we will stand in breach of the convention. If we ignore the judgment, we send the message that dissent is an acceptable state of play, and we would damage our reputation and lose the moral authority to demand compliance from those countries that persistently violate international law. Do we want our record on observing the rule of law compared with that of Russia, Ukraine, Turkey, Azerbaijan and Armenia? It would be neither right nor desirable, but a solution might be closer to home than we think.
	Before the blanket ban came into force under the Representation of the People Act 1969, limited forms of prisoner voting were permissible and even practised. The Forfeiture Act 1870 disqualified convicted felons from voting, but only those serving a sentence exceeding 12 months. Felons serving less than 12 months could legally vote, and where it was practically and logistically possible, some indeed did. In the 1950 general election, for example, postal ballots were returned from prisoners in jails across the country.
	There is more. When the Criminal Law Act 1967 abolished the distinction between felonies and misdemeanours, the concomitant disqualification on prisoner voting came temporarily to an end. In fact, all prisoners could vote. In effect, these prisoners had the right to vote, and it might surprise people that this was not an unintended consequence of the legislation, but a conscious decision based on a recommendation by a law review committee that the practice of prisoner disfranchisement should not continue.
	That policy continued until a ban was introduced in 1969 under the Representation of the People Act, but the point is that the issue was not historically set in stone—not under the Forfeiture Act and not when the United Kingdom signed the convention in 1950—so past precedents should lead the way. To this end, the Government’s proposals on minimum thresholds are worthy of consideration, as they reflect an approach that was deemed compatible with UK law, public opinion and the convention, but we need to step up the dialogue.
	How, then, do we move forward? I believe that the distinction between felonies and misdemeanours is obsolete, but the classification of crimes into indictable and summary offences, which distinguishes between grades of crime, mode of trial and punishment available, continues to apply. Like the old felonies, the most serious indictable crimes are tried before a Crown court, and I believe that this distinction could be used as a building block for a sentence-based solution that recognises the gravity of an offence committed. This is a route that we should consider, and the United Kingdom now has an advantage: the European Court recently reaffirmed its commitment to allowing the UK greater flexibility in how we apply the ruling, providing an opportunity to develop a policy that reconciles both principle with pragmatism and which allows our past to pave the way forward.

Christopher Chope: I think my hon. Friend has made a constructive contribution, but would he accept that what he is saying is totally at odds with what the people of this country believe? They do not want prisoners to have the vote and they do not see why European judges should be bossing them around and telling them otherwise?

Robert Walter: I do not see why European judges should be bossing us around either, but if we stick to the principle that we should do nothing that we did not already do when we signed the convention back in 1950, then we have a pragmatic way forward to deal with the problem.
	I said I wanted to deal with two issues. I want to say a few words to those of my colleagues who are often banging on about Europe. Let me remind them that divided parties do not give the electorate confidence and are generally not re-elected. If those colleagues genuinely want a referendum, they should rally behind the Prime Minister, who has a clear commitment to address the European Union’s institutional deficiencies and to get a better deal in Europe and then put that to the people of this country in a referendum. Carrying on in this mode is a sure-fire way to give Nigel Farage job security, for we will keep UKIP in business for ever if we undermine the Prime Minister and lose the next election. Perhaps some of my colleagues enjoy banging on about Europe and are not interested in the Prime Minister’s endeavours to find a solution, but they will have plenty to bang on about if we have another Labour Government. If they sincerely believe that what we want is a referendum on Europe, let me tell them that the only way we will achieve that is to return a Conservative Government. Therefore, I shall not support the amendment that has been tabled, although not yet selected; I shall definitely be supporting the Prime Minister.

Stephen Timms: I am pleased to follow the hon. Member for North Dorset (Mr Walter). He is right: we have heard a wide variety of views about Europe from the Government Benches in this afternoon’s debate. The most compelling case was the one set out in the first Back-Bench contribution, by the right hon. Member for Mid Sussex (Nicholas Soames). He made a compelling case for the UK to remain in the European Union. He was also right to make the point that what his constituents are really concerned about is the state of the economy.
	That is the background to the Queen’s Speech. There is wide anxiety across the country because of our economic difficulties—rising unemployment and falling living standards. Their root is in the global financial crisis that has engulfed us and others, but they have been compounded by the failure of the Government’s economic policy to deliver what we were promised it would. We were told—I remember the Prime Minister telling us this three years ago—that the policy would deliver steady growth and falling unemployment. Instead, we have had no significant growth since, and unemployment has stayed high. It is rising at the moment and is forecast to become higher still later this year. We will get an update on Wednesday, but the key backdrop to the rather thin Queen’s Speech that we are debating over these few days is rising unemployment, falling living standards and the inability of the Government’s economic policy to deliver what we were told it would.
	There is also a lot of anxiety about what is happening in the health service. That was clear from a survey of 1,700 nurses, the findings from which were published in the Sunday Mirror yesterday. Fifty-five per cent of them said things had got worse in the NHS since the election, compared with 6.5% who said they had got better.
	More than half the nurses surveyed said that morale in the national health service was either poor or at rock bottom. Rather startlingly, more than 40% said that there had not been enough staff to provide safe cover on their most recent shift. It is quite difficult to reconcile that description of what is happening in the health service—which tallies with some of the things we have heard in this debate about what is happening in hospitals—with the rather rosy picture that the Secretary of State presented to us at the beginning of the debate.
	When this Government were elected, they criticised the health service targets that had been set under Labour, but there is no doubt that some of the targets delivered massive and very welcome improvements. In particular, the target for 98% of accident and emergency patients to be seen within four hours was very valuable. I was pleased to hear the Secretary of State affirm its value this afternoon. Before it was introduced, I regularly saw constituents who had experienced terribly long delays in accident and emergency. It was not unusual to hear from people who had been kept waiting all night, for example, but when the target was introduced the problem was resolved completely, and remarkably quickly.
	After the election, this Government weakened the target from 98% to 95%. I am glad that there is still a target in place, but, as I said to the Secretary of State in an intervention earlier, there are growing signs that it is not being hit. The NHS in England has now missed the new, reduced target for major accident and emergency units for 32 weeks running. I hope, as he has reaffirmed the importance of the target today, the right hon. Gentleman will take steps to ensure that it can be delivered rather than be missed.
	I want to mention two other parts of the Queen’s Speech. My first point is not a matter for the Ministers on the Front Bench today, although it is likely to be of some interest to them. The Mesothelioma Bill, announced last week, is the culmination of a process begun by the last Government, in which my noble Friend Lord Mackenzie played an important role. The plan was for the insurance industry collectively to compensate the victims of diseases caused by exposure to asbestos during their employment, often many years previously. Problems have arisen when the original employer’s insurance policy cannot be found.
	The Bill is starting in the other place. I was struck by a report in The Independent on Sunday—not yesterday, but the week before—that the proposal had been so
	“watered down after extensive lobbying from the insurance industry”
	that it would help only a fraction of the victims, and that payments would be 30% lower than was standard. The report went on to say:
	“Department for Work and Pensions minister Lord Freud met insurers 14 times about asbestos between October 2010 and September 2012. Over the same period, he met victims’ groups twice.”
	It also stated that the scheme would apply only to people with mesothelioma and not to the similar number of people affected by other conditions caused by exposure to asbestos, and that one of the victims’ groups had described the Bill as an “insult”. As the Bill goes through the other place and then through this House, I hope that the Government will accept that many of us want to see a fair settlement for asbestos victims, rather
	than a scheme that simply minimises the costs to insurers. We know what a terrible disease mesothelioma is, but the other asbestos-related conditions are also very troubling.
	I also want to comment on the commitment in the Queen’s Speech to ensure that
	“it becomes typical for those leaving school to start a traineeship or an apprenticeship, or to go to university.”—[Official Report, 8 May 2013; Vol. 563, c. 3.]
	I do not know what that means. I searched through the speech made by the Secretary of State for Business, Innovation and Skills on Friday without finding any illumination of that commitment. Indeed, when my hon. Friend the Member for Streatham (Mr Umunna) responded, he accurately described the proposal as “vague”. It is not at all clear what “typical” means in this context, for example.
	I was in Germany with the shadow Secretary of State for Work and Pensions, my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne), last month. In the jobcentre in the town we were visiting, we were struck by the fact that young people were expected either to be on their way to university or to have an apprenticeship place arranged by the age of 15. For the 20% of youngsters who are not in that position, the jobcentre sorts it out for them. I hope that we can do something similar here.

Gerald Kaufman: On a point of order, Madam Deputy Speaker. I am sorry to interrupt the debate, but I need to raise a matter of extreme urgency. At the weekend, a constituent of mine, Augustine Umukoro, came to my surgery to consult me about his immigration situation. He handed me a letter and told me that he had had a meeting with representatives of the UK Border Agency, who said that in two weeks they might have to start removal proceedings, for which they would visit him and his family—his wife and their two children—in their home. I therefore dictated a letter to the Home Secretary today, asking her to look into the matter. Within the past hour, I have had a telephone call from Mr Umukoro to say that when he reported to the UK Border Agency office at Dallas Court in Salford, as he does every week, he and his children were taken into custody. His wife was not, as her whereabouts appeared to be unknown. He was taken down to Heathrow, and he is due to be removed from this country at 10 o’clock tonight without any warning and without the Border Agency having fulfilled any of its conditions.
	I took the matter up with the office of the Minister for Immigration, the hon. Member for Forest of Dean (Mr Harper), half an hour ago. His principal private secretary told me that, as far as he knew, the Minister was content for the removal to go ahead. This is not a removal; it is a kidnapping. It is against every aspect of the rule of law in this country, and I am making it public because it is about time that acts such as these were stopped and because, in this particular case, Mr Umukoro should be allowed, through his Member of Parliament, to make representations.

Dawn Primarolo: As the right hon. Gentleman will know, that is not a point of order for the Chair. He is an experienced Member of Parliament, and he has placed this important issue on the record today, which I suspect was his intention. I am sure that he will continue to hold discussions with
	the relevant Minister right up to 10 o’clock tonight. This is not a matter for the Chamber or for the Chair but, as I have said, I know that he will wish to pursue it elsewhere.

Sarah Newton: The inclusion in the Queen’s Speech last week of a Care Bill in this new Session of Parliament is nothing short of a landmark occasion. Those of us who have been concerned with the reform of our social care system for decades know that those desperately needed reforms, which are well summarised in the Bill, have repeatedly been kicked into the long grass or filed under “Too difficult to do”. Finally, however, we are making progress.
	I have been disappointed by the response to the Bill from Labour Members, who know as well as I do how welcome the proposals are, and what a step forward they will represent for the quality of life of many thousands of people in this country. It was a courageous decision by the Government to introduce the Bill at this time, given that public finances are under enormous pressure as we try to clear up the mess of the financial legacy bequeathed to us by the Labour Government, because the reforms will require additional public finances.
	In the last Session of Parliament, excellent work was done by the group of Members of both Houses in undertaking pre-legislative scrutiny of the draft Bill. That was a good example of how people can bring the experience they have gained outside Parliament into their work as legislators. I am grateful for their consideration of my contribution and the subsequent inclusion in their report of my recommendations. The recommendations resulted from work undertaken with a number of Members across the political parties who worked with the charity Macmillan, looking at what could be done to improve the quality of care of people who want to stay at home at the end of their lives. Ensuring people have a genuine choice over where they die is an issue that is of particular importance to me.
	Last year, I chaired a round table event in Parliament, organised by Macmillan Cancer Support, which brought together carers, health and social care professionals and policy makers to discuss how to enable more people to be cared for at home until they die, if that is what they choose. The expert attendees were clear that access to basic social care support can make the difference between somebody dying at home surrounded by their families or dying in an expensive hospital ward. All too often, however, patients and families cannot access the support because of a lack of integration of health and social care systems or because they cannot afford to pay for it.
	I believe that removing the social care means test for people on the end-of-life care register would lift a significant barrier to the integration of care, allowing many more people to access the support they need and to exercise choice, which could also save the considerable costs of people being in hospital. The Government’s commitment, made in the care and support White Paper, to assess free social care at the end of life through the palliative care funding review pilots represents very good progress. However, with the Care Bill likely to become an Act before the pilots finish in 2014-15, it is also crucial that the Bill allows for the delivery of free social care at the end of life. This would enable the Government to implement the policy without delay, once the pilots report.
	I understand from the responses I have received to written questions that the Minister is undertaking a review of the pilots this year. I very much hope that clauses will be added to the Bill to enable free social care for those at the end of life. Such a step forward would be welcomed by professionals and families alike. It would make such a difference to families at such a difficult time of their lives.
	Another specific aspect of the Bill I would like the Minister to consider—together with the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey), who has responsibility for disabilities—is social care for working-aged adults with disabilities. The debate about the future of our adult care system has very much focused on the elderly and their family and carers. I am as guilty as anyone else of focusing on the injustices in the current system for elderly people and the need for a fairer and better system, but the care system has another group of people who need support: adults who acquire a disability through an accident or an illness. They might not have been working long enough to have savings that they can spend on their care needs and they might have a degenerative condition that has prevented them from working full time. For them, reform of the current system is less to do with how they can protect their assets or how they can pay for care without selling their homes than with how they can get the help they so desperately need.
	The definition of eligibility for care within the Bill is of greater importance than the means-tested threshold and the caps on personal expenditure. We must have a realistic threshold of eligibility, so that people can participate in society as a whole—in education, as volunteers or as employees.
	As the Minister will be aware, some local authorities have, sadly, chosen not to spend the money provided by central Government on the adult social care budgets and have been increasing the eligibility criteria. The Dilnot commission highlighted this concerning trend, and I know that Ministers listened. I understand that the Department of Health is working on amendments to the fair access to care criteria currently used by local authorities. The amendments are reflected in the Bill, which includes new interim eligibility criteria. Concerns have been raised, however, that the interim criteria will not address the continuing shift of social care provision away from those with moderate needs. Research undertaken by the London School of Economics indicates that 105,000 people could lose eligibility if the Government move ahead as proposed.

David Ward: Is the hon. Lady aware that in 2005, 50% of local authorities were setting the level at a substantial 84% for the move from “moderate” to “substantial” needs?

Sarah Newton: The hon. Gentleman makes a very good point, which illustrates the findings of the Dilnot commission.
	I urge the Minister to consider this further and to ensure that the final interim criteria agreed upon, which will be in the Bill, recognise the very real care needs of those who fall into the moderate care category within the current fair access to care system. We found from the report we received on Friday on the Government’s consideration of what improvements might be put into the Bill that they have agreed to look at the eligibility
	criteria and to fund the proposals under the June comprehensive spending review. All that is very welcome. I hope that, once the criteria and the funding to support it have been agreed, the money passed over to local authorities will be ring-fenced for a period, perhaps up to three years. The Government have done that for public health, and doing it in this instance would enable the estimated 105,000 people who have moderate care needs to receive the funding and to continue with their working and volunteering lives, playing their full part in society.
	I am sure that the Minister of State has been listening closely to the organisations that represent people with disabilities. I am also sure he supports the excellent vision and work of the Minister with responsibility for disabilities that aims to enable people living with disabilities to play as full a part in society as possible. I very much hope that, as this Bill passes through the House and is further scrutinised and consulted on, we will address the concerns of these groups of people who all too often fail to have their voices heard.
	The Government have listened hard to the needs of elderly people and have produced a good way forward. These straightforward and common-sense improvements will make a hugely positive contribution to the lives of people at the end of life and those of working age who are living with disabilities. Those people are often living out of sight; we must show them that they are not living out of our minds.

Chris Ruane: I wish to speak on four matters in today’s debate on the Queen’s Speech. The first—heart-related issues—has already been mentioned by my right hon. Friend the Member for Rother Valley (Mr Barron) and by the hon. Member for Mid Derbyshire (Pauline Latham), who is no longer in her place. I am the chairman of the all-party parliamentary group on heart disease, which was set up 12 years ago. I give credit to the Government for consulting on minimum pricing of alcohol and on plain packaging for cigarettes and tobacco. Both those consultations have been good, engaging MPs from all parties and, indeed, the wider community, but the Government have lost a golden opportunity to put these measures in this year’s Queen’s Speech.
	Over the past 10 or 12 years, we have had a fantastic record on heart disease, with deaths going down by 46%. We have taken some big and bold decisions: for example, the Labour Government passed a measure to ban smoking in public places; we also introduced statins, which are largely responsible for the 46% drop in heart-related deaths. We must keep up the momentum, however, and minimum pricing of alcohol and plain packaging of cigarettes could have helped us to do so.
	Each year, about 11,000 10 to 15-year-old children in Wales take up smoking. The industry wants to catch those smokers young and keep them smoking until they are 55, 65 or until they die, in order to keep up profits. Those young people have been deliberately targeted. The hon. Member for Mid Derbyshire mentioned the use of defibrillators and the teaching of resuscitation skills in schools. If the Government made progress on those, it would help to keep up our excellent momentum on tackling heart disease in the UK.
	Many Members have touched on immigration and some have connected it with the health service. There will not be one of us in this Chamber whose life has not been touched by an immigrant worker in the NHS. My doctor for 25 years, Dr Rao—sadly, now passed away—came from the Indian subcontinent, while the man who delivered my first-born child was an Egyptian consultant, and I am really grateful to both of them. If all the immigrants working in the national health service left tomorrow, our national health service would collapse. I pay tribute, too, to the Filipino workers in the care sector—lovely, family-orientated people, who have great respect and great compassion for the elderly. Immigration is an issue throughout the country and we need to reflect concern about it in Parliament. What we do not need to do is add to it. We certainly do not need to whip it up, as I feel some Members have done today.
	I praise the hon. Member for Mid Derbyshire for what she said about cancer treatments. I pay tribute to the work of my constituent Mike Peters, a friend of mine, who has had cancer twice in his life and currently has a chronic leukaemia condition. Mike is spearheading an international campaign to increase the number of donors of matching blood cells for leukaemia treatment. He has set up two organisations, the Love Hope Strength Foundation and Delete Blood Cancer UK. He is a rock star who is a lead singer in The Alarm and Big Country, and he tries to recruit people when he sings in countries around the world. He has personally recruited 35,000 donors, mainly in America, through his concerts, and 500 people’s lives have been saved as a result.
	Mike is holding an event in Room R in Portcullis House on Tuesday 4 June. Anyone—any Member of Parliament!—aged between 17 and 55 will be welcome to become a donor. All it takes is a mouth swab. The DNA is then kept on file, so that anyone in this or any other country who needs stem cells will be able to gain access to them. Let me again pay tribute to the work that Mike Peters has done.
	I now want to say something about how mindfulness can help with problems related to health and social care. Members may ask “What is mindfulness?” Mindfulness is an integrative mind-body-based approach which helps people to change the way they think and feel about their experiences, especially stressful experiences. It involves paying attention to our thoughts and feelings so that we become more aware of them, less enmeshed in them, and better able to manage them. It uses breath as an anchor to slow down the mind and body and to help us to live in the present moment, rather than being chased by our past or worried by our future. It is the perfect way to combat stress—and the impact of stress on heart problems, cancer and mental health conditions is massive.
	Members may think that that sounds a bit airy-fairy, but the National Institute for Health and Clinical Excellence has backed mindfulness as a better way of treating repeat-episode depression than drug therapy. It puts the individual in control. It is as cheap as drug therapy in the short term, and cheaper in the long term. It has no known side-effects, and, if taught early enough, it is preventive. Let me give the House some statistics. A total of 32.3% of people aged between 15 and 25 suffer from one or more psychological conditions. Every Member in the Chamber will know someone with such a condition, perhaps even a family member. In 1991,
	9 million prescriptions for anti-depressants were issued; in 2011, 46 million were issued. That is a 500% increase in 20 years.

Madeleine Moon: As my hon. Friend says, one of the problems on which we need to focus is depression among young people. Young people oppose the idea of taking anti-depressants. Will my hon. Friend say something about the importance of mindfulness in enabling them to build up their self-awareness, their self-confidence and their ability throughout their lives to handle possible recurring depression?

Chris Ruane: I know that the incidence of suicides among young people is a particular issue in my hon. Friend’s constituency, and mindfulness has a role to play in that context.
	Many Members have mentioned compassion today. Mindfulness can help to give compassion to the individual and also to the health care worker. If compassion is lacking, mindfulness can enhance it. It can be used within the health care system, and has been taken up by doctors who are then in a better position to relate to their patients. Earlier this year there was a mindfulness session in the House of Commons for Members of this House and the House of Lords, and another will begin on 4 June.
	Mindfulness can help in a personal capacity, but it can also assist the development of policy in prisons—85% of prisoners have mental health conditions—in education, in the armed forces, in the police and fire services, and in any area where there is trauma. It can play a big role throughout society and in all departments. I urge the Department of Health to recognise that, to act on NICE’s 2004 recommendations, and to ensure that the use of mindfulness for the treatment of repeat-episode depression is fully implemented. I also urge the Department to consider carefully its possible use in other parts of the national health service.

David Tredinnick: It is a pleasure to follow the hon. Member for Vale of Clwyd (Chris Ruane). I entirely agree with what he said about mindfulness and the need for NICE to ensure that it is available for the treatment of stress in particular. That is all the more important now that we have a Government who have put patient choice at the heart of the health service, a fact that will become more and more evident as health and wellbeing boards and Healthwatch start to make an impression through the Health and Social Care Act 2012.
	Like the hon. Gentleman, I intend to focus exclusively on health issues. I shall concentrate not on what is in the Queen’s Speech but on what is missing from it, particularly the expected statutory regulation of herbal therapies. If we are to ensure that the range of treatments that people demand, including mindfulness, are safely regulated in the health service, we must tackle the issue of herbal medicine, which is a crucial tool in our cupboard.
	At this point, I must declare an interest. I was involved in the legislation applying to the last two groups that were made subject to statutory regulation, the Osteopaths Act 1993 and the Chiropractors Act 1994, as a member of the Standing Committees that considered those Bills. Let me emphasise to Ministers how important it is to take that route. It makes practitioners focus on a disciplined
	structure and operate a robust complaints procedure, it makes it easier for doctors to refer, and it makes treatments more widely available.
	When it comes to herbs, we need an interface with European legislation. We must deal with regulation 3(6) of the Human Medicines Regulations 2012, which grants “a person”, not a therapist, the right to practise. What worries me is that Ministers may regulate not therapists but specific herbs. There are thousands of them out there, and that cannot be satisfactory. We must give therapists the right to prescribe. In the case of traditional Chinese medicine, for example, most practitioners will prescribe three herbs to work in conjunction. As I have said in the House before, it works like the Whips Office: there is a chief, a deputy and a messenger. The messenger takes the chief and the deputy to cure the problem. My hon. Friend the Member for Rochford and Southend East (James Duddridge) laughs; of course, that does not always apply to Whips.
	My greatest worry is this: I believe that the statutory regulation has been blocked by vested interests in the orthodox medical community who have said to the Secretary of State “We do not want this, because it will enhance the status of herbal therapists.” If that is true, it is selfish and stupid.
	A sub-set of the problems lies in the fact that there are two types of herbal therapies. There is the “fighter therapy” provided by Hydes Herbal Clinic in Leicester, which I believe is in the constituency of the hon. Member for Leicester West (Liz Kendall), and there is traditional Chinese medicine, which involves the use of different types of herb. We need separate registers to make sure that these therapies are prescribed safely.
	It is interesting to see the headlines that are appearing now. The hon. Member for Vale of Clwyd talked about doctors using mindfulness. One headline states, “GPs prefer herbal remedies to Prozac, says survey”, and one such cited remedy is St John’s wort, which in fact has side-effects if used with other, conventional, medicines. One reason why I want statutory legislation is to make sure that people who are taking herbal medicines can go to their doctors and say, “Yes, I am taking it, and doing so under the prescription of a statutory regulated practitioner.”
	I should say in passing that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has been dealing with this issue, has graciously offered me a meeting to discuss it further, and I look forward to taking him up on that.
	Provision was made in the Health and Social Care Act 2012 for the Professional Standards Authority, which should regulate all complementary therapies other than those provided by individual practitioners, who are regulated under individual legislation. The Society of Homeopaths, which I have supported for years, should be regulated too. Here, we are completely out of line not just with Europe but with Asia and America. We have not used enough of such resources. It is patently absurd to say it is all placebo, given that in Europe 40,000 physicians practise homeopathy, in Asia, 250,000 physicians practise it, and it is practised in Brazil, Nigeria and America. It is not a placebo, because people are using it. One can fool some of the people all of the time and vice versa, but not all the people all of the time.
	The other reason why those who oppose such therapies make some headway is they refer only to randomised control trials. However, we should also consider meta-analyses and patient-reported outcomes. Where double-blind placebo-controlled trials are conducted, they are ignored. Sixty-four of 156 have been positive, and only 11 negative.
	Just a few centuries ago, scientists were saying that the sun went round the earth; now, we know that the earth goes round the sun. Science changes. Here, we should bear in mind what is known as the Semmelweis reflex. When a doctor in Germany discovered that child mortality rates could be reduced if doctors washed their hands, conventional practitioners pooh-poohed the idea, but eventually it became the norm. We have to be progressive, and so it is with some homeopathic remedies, which are so dilute that they cannot be seen through conventional analysis. However, the fact is that those very dilute substances work effectively. The future lies in a wider range of health provision across the health service.
	I want to finish with an e-mail I received today:
	“Dear David,
	From browsing the web I hear you are cynically referred to as the honourable member for Holland and Barrett.”
	Yes, a Labour Minister many years ago called me that. The e-mail continues:
	“If those who jeer had survived a life debilitating illness like Parkinson’s for twenty years, I would have more time for them.
	I have done this while trying to escape the unsolicited attentions of a family populated with several consultants and even more GPs… Alternative therapies like homeopathy, acupuncture, herbs and now helminths are the reason I am alive today.”

Alison Seabeck: It is a pleasure to follow my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the hon. Member for Bosworth (David Tredinnick), who care passionately about health care in its widest and broadest sense.
	This Gracious Speech is unprecedented. I cannot recall in all my years of working in this place, dating back to 1977, another instance of a Prime Minister saying it is okay for their party to vote against the Government’s programme. I cannot see the late Baroness Thatcher condoning such a move. This coalition Government are in meltdown, and the public must be wondering whether any of the proposals in the Queen’s Speech have the wholehearted support of their Members.
	That said, there are measures in the health Bill that could and should be shaped and improved on a cross-party basis. It is therefore important that adequate time be allotted for the various debates and the Committee stage. The proposed programme is hardly onerous, so the guillotining of Bills should not be required—unless the Government decide that they dare not encourage full debate, and chicken out. We shall see.
	Before moving on to the health-related elements of the Gracious Speech, I would like to mention the draft consumer rights Bill because it revisits the private Member’s Bill introduced by my father—Michael Ward, who was a Member of Parliament—which became the Unfair Contract Terms Act 1977. He was supported by the
	late David Tench in enacting what was groundbreaking consumer legislation. Lord Denning, the then Master of the Rolls, described it as
	“the most important change in civil law”.
	My father would, if he were alive, be very keen to ensure that the streamlining and simplification process in bringing together so much consumer legislation does not water down consumer rights.
	There are a number of health-related proposals in the Queen’s Speech. In Plymouth—a mesothelioma hot spot because of the nature of its industrial base—people will welcome the further progress that has been made on speeding up the process through which insurance companies accept liability and pay compensation. However, for too many of my constituents progress has been tragically slow: they have not survived this awful disease long enough to benefit from the legislation. We have a moral duty to do everything we can to support the victims, and we need to ensure that the Bill, which has had a very slow gestation—it was discussed under the last Labour Government—does what it says on the tin and guarantees faster pay-outs. The failure to address other asbestos-related diseases is also giving rise to concern.
	Those who are more fortunate are now, with support, living into grand old age, and we have to resolve the issue, which has dogged successive Governments, of providing care for our older citizens, as well as younger people with illness or disability. The care and support Bill should be welcomed as a step in the right direction, but I fear it will not be enough and, rather than having a full-blown national care service, we will end up with a piecemeal one. The level of the cap has been set too high—higher than Andrew Dilnot recommended—and without investment in local services the Bill will have serious consequences, as clearly set out in the opening speech of my right hon. Friend the Member for Leigh (Andy Burnham).
	To deliver much of what will need to be delivered, local authorities will therefore be required to step up to the plate—the joined-up care that the Secretary of State talked about. Yet we know that many are having to dismantle the architecture upon which good care and support is offered—as we are seeing in Torbay, an exemplar—because of the deep cuts being made to their budgets. Can the Government please be clear about who will be running these care and support networks? If it is the private sector, how will they ensure that there is not a postcode lottery?
	Oddly, earlier the Secretary of State was behaving like one of those nodding dogs we see in the backs of cars when it was pointed out that hospitals are under pressure and staffing levels are not all they should be. However, he has provided no real answers in this Queen’s Speech.
	At long last, after almost four years, we have a Bill paving the way for a potentially dramatic change to the way defence procurement is carried out. There is consensus across the political divide that successive Administrations did not sufficiently reform defence procurement. Equipment programmes were overheated in respect of funding, and the Ministry of Defence was underpowered in the skills required to deliver increasingly complex programmes. There are too many questions that need to be asked for the time available, and today is not about defence, but we will need to come back to those questions. The themes, however, are the accountability of the proposed GoCo
	—Government-owned, contractor-operated organisation —and where the risk lies. For example, does it lie with the taxpayer or with the private company? Warning bells are already ringing around Westminster about the management of risk. We know from successive Public Accounts Committee and National Audit Office reports that the MOD struggles when it comes to assessing risk. We need to know whether the Ministry of Defence, like the Department of Health, is producing legislation that removes the Secretary of State’s power to intervene and take responsibility.
	Finally, I come to the Bills that were not mentioned. My right hon. Friend the Leader of the Opposition emphasised the missing legislation in his response to the Loyal Address. The cold hand of the Prime Minister’s henchman, whose links to the tobacco industry as a lobbyist are well documented and who has accepted major donations to his campaign in Australia from British American Tobacco, is writ large on this Gracious Speech.

John Leech: I agree that not having legislation to introduce standardised packaging for tobacco products is the wrong decision, but does the hon. Lady agree that it is appalling how the unions, too, have tried to stop this legislation?

Alison Seabeck: People work in those industries, and, understandably, the unions representing them have to consider the membership’s point of view. Among the unions as a whole, there is a broad range of views, very much reflecting those in this place today.
	Returning to my point, perhaps that is why No. 10 has U-turned, from a position where it was wrong for children to be attracted to smoking by glitzy designs on packets and there were statements that children should be protected from the start, to the obverse position, where we are not being allowed to have legislation that would have a beneficial impact on the future health of our population and on the NHS budget. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, we need to know who is pulling the strings in setting Government policy. The Government have bottled it; they are in thrall to their right wing. Young people in Plymouth, particular our Youth Parliament members and those in our youth cabinet, who wanted very much to see this change brought forward, will feel that they have been sold down the river. Many young people are asking what is in the Queen’s Speech for them; there is nothing to protect their future health and nothing to help them into work.
	If the Government were serious about improving the health of the nation, we would have given these measures a fair wind. They would have had broad support from the Opposition, as would investment in other areas, such as housing that is affordable to rent, because good housing equates to good physical and mental health. Nothing has been said on those issues. The Queen’s Speech is a huge missed opportunity, and it is simply not good enough.

Gary Streeter: It is a real joy to follow the hon. Member for Plymouth, Moor View (Alison Seabeck), my next-door neighbour—you are being extremely skilful in your selection of speakers
	today, Mr Deputy Speaker. I very much enjoyed her contribution; she spoke in her usual trenchant and passionate style. I also enjoyed hearing about the work that her late father was involved in, and I can say with some confidence that he would be extremely proud of her and all that she has done in her time as a Member of Parliament.
	I liked the Queen’s Speech, but it was a little long for my liking. I was looking forward to the Queen sitting on the throne and saying, “My Government have decided to introduce no new laws this year, but to concentrate on implementing and overseeing well the policies that we have already passed and the laws that we have already put in place.” As we all know, coming to the House and taking legislation through involves a huge time commitment for Ministers, and there is a huge case to be made for Ministers to focus on implementing well the things that we have already decided. We have been radical in the past three years in this Parliament, so let us make sure that the policies now work in practice on the ground—let us set our Ministers free to do that. Interestingly, the key areas our constituents are most concerned about—getting the deficit down, getting the economy moving and cracking down on immigration—do not require any legislation at all. They simply require us to do well the things we have already decided.
	I welcome the Queen’s Speech and, despite having said what I just said, the increased attention on immigration, which is what our constituents want. The reaction of my constituents to some of the tough measures we have introduced so far on immigration and on welfare changes is, “It’s about time. We have been waiting for this for many years.” So I support the broad direction of travel of the Government, and I have full confidence in the Health Secretary.
	I want to make two points in a brief contribution about health issues, the first of which is about the challenge of urgent care. Our parliamentary system has many strengths, but one weakness is that every Government Member is inclined to say that everything we are doing is wonderful, while the Opposition are inclined to say that everything we are doing is rubbish. We all know that the truth lies somewhere in between. I support and pay tribute to the fact that we continue to pump fresh money into the health system year after year. The shadow Health Secretary is convinced that we are not meeting our commitment to increase health spending above inflation every year—I think we are, but of course there is a debate to be had. I do know that there are pressure points in the health system that need to be tackled, and urgent care is one of them.

Andy Burnham: The hon. Gentleman’s association with the detail seemed to be loose there; Andrew Dilnot wrote to the Government to say that health spending was lower in real terms in 2010-11 than it was when Labour left government. It is important to point out that the promise the hon. Gentleman stood on was for real-terms increases in every year of this Parliament and that that has not been honoured.

Gary Streeter: That is Andrew Dilnot’s opinion, but it is not mine—that is the point I am seeking to make. [Interruption.] The right hon. Gentleman’s speech was riddled with references to spending—more spending on health and on local councils—but is he not aware that
	this year the deficit in this country will still be, even after three years of austerity, £110 billion? If he comes to the Dispatch Box to make speeches about extra spending for health and local councils, he is obliged to tell us where that money will come from. At the moment, I can see no signs of it whatever.

Andy Burnham: rose—

Gary Streeter: I will not take any further interventions, but let us not hear any further speeches calling for extra spending unless we know where the money is coming from.
	As I was saying, before I was so rudely interrupted, there are pressure points in the health system, and urgent care is one of them. This is about not only accident and emergency departments, but GP and out-of-hours services, community nursing, social care, ambulance services and hospital beds—there is pressure on all those points.
	The hon. Member for Plymouth, Moor View and I are fortunate to go to Derriford hospital in Plymouth for briefings. I have been going slightly longer than she has—21 years—and I can tell the House that in good times and in bad times Derriford hospital is under pressure. It has a running capacity of about 95%, which means that when there are spikes, as there have been this winter, it can be running at 103% capacity, which puts the hard-working staff under enormous pressure. Even when the Labour Government were spending money as though it were going out of fashion, I have never gone to Derriford hospital and had the staff tell me, “It’s fine. There are no pressure points. Everything is working in our health service. It’s all working well and waiting lists are coming down.” That has not happened once in 21 years.

Stephen Phillips: Does my hon. Friend agree that perhaps one problem with the Queen’s Speech, and one of the issues with which neither Ministers nor shadow Ministers tend to grapple, is that there is a real problem in this country with demand? Unless and until we grapple with that, the national health service will always be under pressure.

Gary Streeter: I completely agree with my hon. and learned Friend, and I might come on to deal with that point in a moment.
	The point I wanted to raise with Ministers is that the funding formula for emergency work needs to be reviewed. As I understand the system, the formula is based on the 2008-09 baseline, and any extra patients who come into an acute hospital over and above that baseline are paid at 30% of the tariff. It costs hospitals 100% to meet the needs of those people coming in, yet they are paid at 30%; the extra 70% is supposed to be spent by other health care agencies in providing alternative centres of treatment, which are intended to divert people away from acute hospitals. I am pretty well plugged into what is going on in my constituency, and I have not seen anything since 2008 that looks vaguely capable of diverting pressure away from Derriford hospital. The system of allocating 30% to the hospital and 70% elsewhere is simply not working. I ask our Ministers to look urgently
	at that formula and to find out why, if it is not working, we are still using it and to address that. I am not calling for extra money; I am calling for money to be diverted to the acute hospitals, because they are where the pressure points are. In my constituency, there have been no realistic options for treatment other than to go to Derriford hospital. So, such hospitals should be receiving not 30% but 100% of the tariff.
	My hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) is absolutely right about demand growing exponentially. In 1979, if a man reached the age of 65, they could expect to live until they were 77. If a man reaches the age of 65 now, they can expect to live until they are 88, and of course that age is rising year on year, so the demand is going up.
	One thing that we are noticing is that although the number of people admitted to the emergency department at Derriford hospital in the last 12 months has been stable, there is much higher acuteness—in other words, people are much sicker and therefore it requires a lot more effort to treat them. Please, nice Ministers on the Front Bench, may we have a look at that formula for the funding for people accessing acute hospitals on an emergency basis?
	My final point, in the one minute of my time that remains, is that 20 years ago or so I made a speech in this House saying that the health service had lots of challenges, issues and problems, but that one of the things we did not need to touch was primary care as it was working fine. I cannot make that speech today. I will not hammer the Opposition again about the GP contract, but in the past few years constituents have been complaining to me in a way that they never did in the previous 15 years to say that accessing their GP is becoming extremely difficult. For someone—whether they are a mum with a young baby, or a senior citizen—to get a surgery appointment when they want it has become a serious issue in the past few years. Addressing that issue does not necessarily require legislation, but may I ask Ministers whether we can please put in place a system whereby GPs give the seven o’clock in the morning to seven o’clock at night, seven days a week service that this country so desperately deserves?

Paul Blomfield: It is a delight to follow the hon. Member for South West Devon (Mr Streeter). I might not have agreed with everything he said, but he was right to point out that away from this place people’s concern is about economic growth. Sadly, the Queen’s Speech does not adequately address that concern.
	Some of the less thoughtful contributions have demonstrated just how deeply divided this Government are—not between parties, but within the main party of government. The Prime Minister is unable to command the support of his own party. When he makes a decision, it is often the wrong one, putting party squabbles before national interest.
	Just for one moment, let us imagine the scene in Washington today. The Prime Minister is there to seek the ear of the President on the EU-US trade deal, which is hugely important to this country and worth £10 billion a year. As the President received his pre-meeting briefing, I wonder what his advisers would have been saying:
	“Don’t waste time on this Prime Minister, Mr President. He has only two years left. He can’t even command the support of his own party. His Cabinet members are speaking out against him as they jostle for succession, and he has even told members of his own Government that they can vote against him on the Government’s programme. We will have to talk to the people that count in government—ignore this one.” As Barack Obama raises his eyebrows in incredulity, British influence disappears out of the window because of the weakness of this Prime Minister.
	That situation is also demonstrated in the Queen’s Speech, and as much by what is not included in it as by what is. When the Prime Minister makes a decision, too often he buckles to pressure from the wrong people, backing powerful vested interests against those of ordinary people. As a number of my colleagues and a number of Government Members have done, I want to highlight the absence of the promised legislation for standardised cigarette packaging, which sacrifices the health of our children in favour of the profits of the big tobacco companies.
	Back in February, the Prime Minister talked clearly about introducing legislation for standardised packaging. The papers reported that
	“Ministers are convinced that the ban is necessary to take the next step to reduce smoking in the UK.”
	Those reports were confirmed by a senior Whitehall source, who said:
	“We are going to follow what they have done in Australia.”
	The source correctly went on to say:
	“The evidence suggests it is going to deter young smokers. There is going to be legislation”.
	That was what we were all expecting, although perhaps some of us were surprised that the Government had actually got it right on this issue and were putting people first—that was, until just a few days ago. I do not know whether they were under the influence of Lynton Crosby—bear it in mind that he earned considerable sums of money from the tobacco lobby, and that he failed to win the argument against standardised packaging in Australia before bringing his toxic approach to politics here—or perhaps they were just running frightened from the UK Independence party’s opposition to public health measures against smoking.

John Leech: I note that the hon. Gentleman does not mention the intervention of the unions and their support for retaining the existing system of packaging. Would he like to condemn the position that the unions have taken on standardised packaging?

Paul Blomfield: My understanding is that the majority of unions would support standardised packaging. I deeply regret the fact that the tobacco giants use some individual trade unionists as de facto lobbyists.
	The Government surrendered to the tobacco giants. What message does that send to the country? This Government are prepared to see people die and, as the hon. Member for Mid Derbyshire (Pauline Latham) said, die horribly, and in their hundreds of thousands, to prop up the profits of the tobacco industry. There are no industries like the tobacco industry—the more cigarettes it sells, the more money it makes and the more people die.
	Since science confirmed the link between smoking and lung cancer, the tobacco industry has opposed every single measure to reduce smoking. We all know that smoking is the largest preventable cause of cancer; it is responsible for four out of every 10 cancer deaths. According to Cancer Research UK, tobacco is responsible for 100,000 deaths in the UK every year. We have made huge strides with the measures that have already been taken against smoking, but as we have encouraged people to stop smoking, the tobacco giants have been building their market among young people. A report from Cancer Research UK in March showed that the number of children smoking had risen by 50,000 in just one year.

Frank Dobson: Let me demonstrate the absolutely vile morality—if I can combine those two words—of the tobacco industry. When it was discovered that nicotine was addictive, the industry increased the proportion of nicotine in cigarettes to make them more addictive. People like that should not be listened to; they should be shown the door.

Paul Blomfield: I agree with my right hon. Friend: the tobacco industry should not be listened to. However, it finds no end of ways to seek to defeat the arguments of public health lobbies against smoking, and indeed to encourage the wider use of cigarettes.
	Shockingly, in the last year for which figures are available about 207,000 children aged between 11 and 15 started smoking. The vile way—to use my right hon. Friend’s word—in which the tobacco giants operate means that that is a direct result of the industry’s marketing strategies, which are as sophisticated as they are cynical. Flavoured cigarettes have been introduced, and not only menthol, but chocolate and fruit flavours. Some cigarettes are targeted at young women. Even the Daily Mail pointed out, in condemning that move, that those cigarettes seek to
	“make smoking look elegant, sexy and classy”.
	Alternatively, as British American Tobacco’s Hinesh Patel said, almost acknowledging the company’s strategy:
	“We’ve taken a creative approach to respond to the female under-30 demand for a smaller, slimmer, less masculine cigarette…a contemporary product in a new accessible size.”
	In that context, packaging is crucial. A Saatchi & Saatchi marketeer said this of British American Tobacco’s Vogue package:
	“The cigarettes look like something found behind a glitzy counter at Selfridges....trying to capitalise on a woman’s desire to feel beautiful to sell their cigarettes.”
	The Government public health Minister, the hon. Member for Broxtowe (Anna Soubry), is not present, but she has made her views on this subject clear. In April, she said before a House of Lords Select Committee:
	“We know that the package itself plays an important part in the process of young people and their decision to buy a packet and to smoke cigarettes.”
	All the experts back standardised packaging, and until a few days ago we thought the Government did, too. The public back that as well, with 63% in favour and only 16% against, according to recent polling. This Government are getting it wrong again. They are showing again that they are out of touch with people and they are on the wrong side of the argument, and I urge them to think again.

David Ward: I want to congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on her contribution, and I hope to add to her comments.
	A quiet revolution is taking place. Slowly—although probably not very slowly—but surely, the life chances of thousands of vulnerable people are being changed. We in Bradford did a huge amount of survey work following the publication of the health and social care White Paper, the Bill and the progress report on funding reform, and we received a huge response with more than 500 direct responses from within the constituency. I want to pay tribute to Bradford council, which was very much involved, as well as the Bradford and District Age UK, the Bradford Alzheimer’s Society, Ideal Care Homes, Bradford disabled people’s forum, the Consortia of Ethnic Minority Organisations and also the area manager of Specialist Autism Services, who submitted a response last week.
	The report was published after a Westminster Hall debate on this subject, and many of the Government’s proposals were generally welcomed. Some areas caused concern, however, including on hospital discharges, specialist housing, and waiting times for adaptations. Much of the concern is less about legislation and more about local delivery—about what is actually in place in the locality.
	The backdrop to everything we are doing in all policy areas is the austerity programme and the deficit, and many local authorities are facing severe funding cuts as a consequence of the measures being taken,. Their effects are being exacerbated by the increasing demand for social care. In my area, there will be an additional 5,000 over-65s in the next 10 years and a 38% increase in the number of over-85s. There will also be a large increase in those with learning disabilities. This will add an extra £10 million to local costs. A lot of complex cases are arising, and all of this must be seen against the backdrop of the cuts and changes.
	The Government say that local authorities must decide on priorities. That is true, but it is also a bit dishonest. The national health service budget, for which the Government are seen as responsible, is protected, but the social care budget, which is predominantly picked up by local authorities, is under attack and being cut. If many of the preventive measures we are seeking to introduce enable people to go home sooner and have a better experience on their return from hospital, that will reduce the pressures on the NHS budget but increase the costs facing local authorities, as they will have to pick up the costs arising from those successful preventive measures. Things will be difficult for many local authorities, therefore.
	The report we in Bradford produced following the publication of the Bill focused on residential care, and since then we have done a lot more work on another crucial, and topical, area: Bradford council has, through a consultation process, been addressing the fair access to care services—FACS—criteria, and I will focus on the criteria for the provision of social care. I mentioned discharge from hospital and adaptations, but the level at which the FACS criteria are set is crucial in determining the services many people will receive in their homes and the life chances and experience they will have.
	The “critical” criteria include when “vital social support systems” and
	“vital involvement in work, education or learning cannot or will not be sustained”.
	A person’s care and support needs are deemed as “substantial” when
	“many aspects of work, education or learning cannot or will not be sustained.”
	We understand all that, but the bit I am not comfortable with is the description of anything lower than that as being “moderate.” That is a terminological inexactitude or misnomer. Listed under “moderate” are
	“an inability to carry out several personal care or domestic routines and/or...several aspects of work, education or learning”.
	I do not regard that as being “moderate.” The ability to do such things is often essential if people are to live a satisfactory life in their own homes and as part of their local community.
	In plain and simple terms, and without trying to be funny, if someone cannot get their knickers or underpants on in the morning, they will not go to the day centre, however good it is, and if someone does not get the help to get the right tablets in the morning, they will not be going to the day centre in a minibus; they will go to hospital in an ambulance. We must not call this level of need “moderate.” For many people, it is essential if they are to have a full life in their community and in their home.
	We must look less at what can be funded and more at what levels of need we need to fund. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) pointed out that much of the proposed legislation is about intervention and prevention, on the basis that prevention is better than cure, but the danger is that today’s moderate needs will become tomorrow’s substantial or critical needs if they are not met at the correct time. This is not about cutting our cloth or making do in times of austerity. It is about, foolishly, making short-term savings to the detriment of future taxpayers who will have to bear the costs of what should, and could, be regarded as avoidable needs.

Roberta Blackman-Woods: My hon. Friend the Member for Sheffield Central (Paul Blomfield) made a powerful case against the influence of the tobacco companies and their lobbying of this Government, and the utter ineffectiveness of the Prime Minister in standing up to them. I am also pleased to follow the hon. Member for Bradford East (Mr Ward), who made an impassioned plea on behalf of his constituents and others. He demonstrated the need for proper local authority funding to support care services, and I will address that later in my speech.
	I think it is true to say that all independent commentators are noting that the Gracious Speech was very thin and did not rise to the many challenges facing this country, particularly the need for economic growth. I was therefore concerned to hear speech after speech in which Conservative Members talked only about Europe in a very obsessive way, without any recognition of the fact that constituencies such as mine that are desperately in need of economic growth rely on our relationship with Europe. Our region exports the most from this country, and a huge proportion of our exports are to European countries. We need
	those exports to grow, not to be damaged by the rhetoric on Europe that we hear day after day from the Government and Conservative Members.
	I was also concerned when I listened to the Secretary of State for Health and heard how complacent he is about the state of the NHS. He showed no recognition at all of the anxiety of many of my constituents about what sort of health service we are going to end up with in a couple of months’ time and whether it will be able to meet their most basic needs. He showed no awareness at all of the challenges facing A and E departments right across the country, including my own in Durham. I am not criticising the staff, who struggle against the odds to provide the best care. This is happening because the Government are not looking at how to use the resources effectively and how to channel them towards under pressure A and E departments.
	It would be extraordinary if we did not have a Bill on care in this Queen’s Speech given the clamour for it from carers, carers’ organisations, other agencies, cross-party commissions, and cross-party groups, and some of the work that Labour did when in government. The question remains, however: is the Bill up to the job of dealing with the problems facing our care system, which need to be addressed urgently because, as we all know, it is in danger of falling into crisis. The House of Commons Library has produced research showing that 10 million people in the UK are over 65 and that by 2030 the number is projected to rise to 15.5 million. Many of these additional older people will have care needs, putting increasing pressure on our care system. At the same time, more funds are being stripped from social care. The £500 million funding gap in our social care provision is still growing and, as Age UK has made clear, this is having a hugely detrimental impact on the care received by our elderly people. Age UK states that
	“the widening funding gap has led to a reduction in service provision, increasing charges levied by councils for their services and less older people receiving the support they need.”
	It further says:
	“Every older person using local authority care services is now being charged £150 per year more in real terms in 2010-11 than in 2009-10, and £360 more than 2008-09”.
	The situation is expected to get worse still. Due to the massive cuts faced by local government, by 2013-14 local authorities will have reduced their expenditure on adult social care by £2.7 billion—a massive 18% reduction when demand is increasing all the time. Clearly, this is not sustainable.
	The Bill will do nothing to close the growing funding gap or to help the thousands of people who are already suffering with spiralling living costs and increases to home care costs. These people find themselves passed between care providers, often without any continuity of service. We will all have heard about such experiences in our constituency surgeries. Many people are ending up in hospital unnecessarily because they are not getting the care they need at home. Similarly, the Government’s earlier decision to ignore Dilnot and the experts who recommended a maximum cap of £35,000 and set it at £72,000 plus accommodation costs will not help many of my constituents, particularly those on lower or middle incomes.
	Where the Bill might make some meaningful progress is with regard to improved rights and support for carers, but, as several hon. Members have said, there are huge
	gaps, particularly in identification of and support for young carers. That will need to be addressed as the Bill makes its way through the House. More needs to be done to support the various organisations that help carers. I work with a number of voluntary sector bodies in my local communities, and they are very worried that they will go out of business because they are not able to get enough resources to keep going.
	Carers UK has set out some tests of this Bill. It says that it needs to be underpinned by appropriate funding, that it must promote the well-being and dignity of all our elderly residents, that it must ensure that independent advice is available to people and that there are appropriate advocacy services, that it should make sure that the criteria for people to get support are clear and transparent —it is no good just having assessments; they have to produce something in the form of appropriate levels of care—and that it must guarantee continuity of service and portability in whatever care support is given. I hope that as the Bill goes through the House it will be tested on those criteria.

Eric Ollerenshaw: I am pleased to follow the hon. Member for City of Durham (Roberta Blackman-Woods), who picked up the theme of the hon. Member for Bradford East (Mr Ward) in talking about social care, which I too should like to remark on.
	Unlike others, I will not be tempted into the subjects of tobacco, Europe or gay marriage but will stick fundamentally to the title of this debate on health and social care. I have a few specific points to make about the impact on my constituency. In general, though, I am proud to be part of a Government who, despite the need to eliminate the huge budget deficit left to us, have protected spending on the NHS. That has been necessary, in large part, because of the demographic changes that are happening in the UK with a rapidly ageing population. We need to do more than just target health spending on the older population; we need to change the way we think about providing care for the elderly and what this means for our society. I think that that is what other hon. Members are working towards as regards the cross-over between social care and health care.
	I warmly welcome the inclusion of the Care Bill in the Queen’s Speech and the Secretary of State’s comments about personal health care and social care plans for the elderly. We can all make criticisms in saying that more should have been done, but the fact is that this Government have actually done it. The previous Government kept promising to do something about the tragedy of people having to sell their homes to pay for care; this Government have set about doing it by introducing a Bill that will end that tragedy by introducing a cap on care costs. That is remarkable given the background of the deficit we face. The implications of that will be borne out when the electorate understand that finally a Government have committed to go this far.
	I firmly believe that this is the right way forward. It has been clear for some time that we needed to create a long-term solution to allow people to plan with confidence for their future. Now other generations, too, can plan how they want to look after themselves in old age because they know that the cap is there and that there will be a higher means-testing threshold allowing them
	to put some money aside to address these issues. We have already heard in this debate arguments about the threshold, the cap, and the way forward. However, I hope that Labour Members will recognise that, as the right hon. Member for Leigh (Andy Burnham) and the hon. Member for Worsley and Eccles South (Barbara Keeley) indicated, we need to find a bipartisan way to deal with this fundamental demographic issue facing the population of this country and try to shift it out of the political arena.
	Having talked about social care, I now want to address NHS funding more broadly. As I have said, I am proud that NHS spending has risen in real terms over the life of this Parliament, but the historic formula used to distribute NHS money around the country needs to be reassessed. Although it is correct to factor in depravation when deciding where funds are allocated, a bigger weighting needs to be given to the age of the local population. A recent Age UK briefing note stated that at any one time about 65% of hospital patients will be over the age of 65, while, according to national statistics, areas with the highest depravation are also likely to be those with the youngest population. At present, therefore, those parts of the country with the highest numbers of older people have to deliver highly specialised services and care without a funding formula to assist them in their work. Moreover, as a Member representing a semi-rural part of the country, I see at first hand the effect that geography also has on the delivery of services and the extra costs involved in delivering quality health care over a wide area.
	Lancaster is part of the Morecambe Bay NHS Foundation Trust. It is a pleasant and wonderful geographical area, but it is enormous. It has three hospitals—in Lancaster, Barrow and Kendal. The distance between the hospital in Barrow, which offers some specialist services, and that in Lancaster, which offers others, is 50 miles by car, but the hills and dales mean that it sometimes takes one and a half to two hours to travel between the two. Nothing in the national formula acknowledges the problems faced by the trust. Specialist services need to be retained in as many of those hospitals as possible if journey times are to be kept to acceptable levels, which means that they will require proper funding to allow them to operate. I look forward to working with my hon. Friends the Members for Suffolk Coastal (Dr Coffey) and for Beverley and Holderness (Mr Stuart), as well as others, to try to tackle this unfair disparity with regard to some geographical areas.
	I want to pinpoint how the problem affects us locally. The Royal Lancaster Infirmary has a vascular service unit and, despite the excellent clinical outcomes it has delivered for years, it has been suggested that it should close. That would leave a service gap between Carlisle in the north and Preston in the south of nearly 90 miles. It would leave patients from the more rural parts of my constituency, especially those from Barrow or south Cumbria, with lengthy journeys if they needed specialist treatment. Some areas are well outside the 90-minute transport target time, which is already an extension of the national target of 60 minutes.
	That delay in journey time is a genuine issue for consideration when establishing where specialist services should be located, as has already been proven by the decision to retain a vascular service in Carlisle, where
	an exception was made to most of the scoring criteria because of the local geography and the time it would take to transport patients elsewhere. If exceptions are rightly being made in one part of the north-west, they should apply to other areas where substantial delay is likely to occur. As I have already said, under the current plans there is a huge geographical gap in service provision between Carlisle and Preston.
	The closure proposal has been referred to the Secretary of State for a final decision and I sincerely hope that he and his Ministers will decide in favour of retaining the specialist provision at the RLI. That, however, is just one example. A more wide-ranging review is being undertaken of service provision across north Lancashire and there are concerns that our local A and E unit may be under threat as a result of geography not being taken into account.
	The funding formula needs to change to take greater account of those parts of the country with an elderly population. It also needs better to reflect the difficulties of providing services in large geographical, sparsely populated areas. Without that and the accompanying reallocation of resources, hospitals in rural and semi-rural areas will struggle even more to provide the necessary services to their residents. I urge the Secretary of State to look into this as a matter of urgency.

Ian Mearns: I am pleased to follow my hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and in particular my hon. Friend the Member for Sheffield Central (Paul Blomfield), who made a very strong speech about the Government bottling the proposal for plain packaging for cigarettes.
	The response to the Queen’s Speech from my constituency of Gateshead, the north-east and the whole country is: what a missed opportunity. Research by Sheffield Hallam university highlighted recently in The Times illuminated the impact of welfare reforms on local areas across the whole of Britain. The impact varies from place to place: the worst affected areas face financial losses that are twice the national average and four times those in the least affected areas, and—surprise, surprise—it is Britain’s regions and older industrial areas that are hit the hardest, whereas much of the south and south-east of England outside London escapes comparatively lightly. As a general rule, the more deprived the local authority, the greater the financial hit. Professor Steve Fothergill, who undertook the study, said that
	“the Coalition government is presiding over national welfare reforms that will impact principally on individuals and communities outside its own political heartlands.”
	So that is what they mean by, “We’re all in this together.”
	What are the Government’s priorities? A local audit Bill, a water Bill, a deregulation Bill and, in terms of health, a chronic outbreak of Europhobia. Those are hardly the country’s priorities. Meanwhile the country and its people in regions such as mine continue to suffer.
	New research in a book published this month, “The Body Economic: Why Austerity Kills” by the respected political economist David Stuckler and the physician and epidemiologist Sanjay Basu, shows conclusively that austerity policies are
	“seriously bad for our health”.
	They argue that in Greece, HIV infections have risen by more than 200% since 2011, as prevention budgets have been cut and intravenous drug use has grown amid 50% youth unemployment. Greece has also experienced its first malaria outbreak in decades, after budget cuts to mosquito spraying. David Stuckler has said:
	“Austerity is having a devastating effect on health in Europe and North America. The harms we have found include HIV and malaria outbreaks, shortages of essential medicines, lost healthcare access, and an avoidable epidemic of alcohol abuse, depression and suicide, among others. Our politicians need to take into account the serious, and in some cases profound, health consequences of economic choices. But so far, Europe’s leaders have been in denial of the evidence that austerity is costing lives.”
	Despite the clear evidence, the coalition is taking no action on minimum pricing of alcohol or on plain packaging of tobacco products. It has capitulated to manufacturers, lobbyists and self-interested advisers. In the face of the clear and unequivocal damage that this coalition’s policies are doing to the health of our nation, it has no appropriate response, despite the fact that we all know that prevention is better than cure. My hon. Friend the Member for Sheffield Central highlighted the number of people who annually die prematurely as a result of cigarette smoking. Over the weekend Wembley stadium was almost full for the FA cup final; imagine that number of people dying annually as a result of preventable disease induced by smoking.
	A health warning should be printed on this Government: “Warning: this Government’s policies will seriously harm you and others around you, and will detrimentally impact your mental health and that of your family and friends.” We have heard example after example. It was reported this week that, sadly, Stephanie Bottrill killed herself on 4 May. Already struggling financially, Stephanie faced the devastating prospect of the bedroom tax. In a suicide note left for her son, she said that
	“the only people to blame are the government”.
	Stephanie’s case is, of course, only the tip of the iceberg. Since this Government came to power the website Calum’s List has listed 33 cases where a coroner has recorded that an individual has been driven to suicide by welfare cuts.
	On the evidence of this Queen’s Speech, the Government clearly do not understand or care about the human cost of what is happening. It is equally clear that they do not understand or care about the economic devastation that their policies have brought to significant sectors of our economy. Do they read the IMF reports on our economy? Do they even know how to contact the IMF to talk about them?
	Having read the Queen’s Speech, it appears that the Government have no idea what to do. They seem like rabbits stuck in the headlights of their own rhetoric. The plans are more and more and more of the same: cuts followed by cuts followed by more cuts. With sectors and regions of our economy stuck in a spiral of decline, the country needs leadership, yet we have a vacuum of a Queen’s Speech. We need leadership to get us out of the problem, not dig us further into it, but instead we have a coalition strangled by indecision and political inertia. Where are the plans for growth? Where is the growth Bill, the national recovery Bill, or even the “We understand what the problem is” Bill? The Government seem to have no idea how to move things forward. There is not one substantial proposal in the speech.
	It is not just me, my hon. Friends and the IMF who are saying that. Even the Chancellor’s new Governor of the Bank of England, Mark Carney, said only last month that Britain is an economy in crisis. He compared the UK with basket case countries in the eurozone. Speaking on the fringes of the IMF’s spring meeting in Washington, he said:
	“The US is breaking out of the pack of crisis countries that includes the euro area, the UK and Japan.”
	That pales into insignificance compared with the words of the IMF’s chief economist, Olivier Blanchard, who said last month that Britain was “playing with fire” by pressing ahead with austerity. We need change and we need action. The Queen’s Speech delivered neither.

Robin Walker: It is a pleasure to speak in the debate on the Humble Address that was proposed so elegantly by my neighbour and hon. Friend the Member for Mid Worcestershire (Peter Luff), in whose speech I was named and suitably embarrassed. I was grateful for the kind tributes that were paid to my late father by my hon. Friend and the right hon. Member for Doncaster North (Edward Miliband), the Leader of the Opposition. I was keen to speak in today’s debate because what the Leader of the Opposition referred to as “that voice of moderation” and what my hon. Friend rightly identified as the middle way, the spirit of one nation conservatism, is not, as the right hon. Gentleman tried to suggest, unfashionable, but is at the heart of this Government’s programme and embedded in the Queen’s Speech.
	“Efficiency with compassion” were the watchwords of my late father. He believed that a balance of the two was essential to meet the challenges of the hour and the needs of our country. I believe that the same is true today. Compassion has been shown by the coalition Government in introducing the Care Bill and by being the first to introduce legislation to cap social care costs. I spoke in the debate on last year’s Gracious Speech to express my disappointment that there was no such legislation and to support Opposition Members who were calling for it. It would be churlish of those who spoke out then not to recognise the enormous significance of the move in this Gracious Speech.
	By setting a cap, albeit a higher one than many of us would have liked, the Bill will start the process of ensuring that nobody has to lose their home to pay for care. Setting a cap at any level should help the insurance industry to create products that protect thousands more people from that risk. The threshold, as the right hon. Member for Sutton and Cheam (Paul Burstow) pointed out, is key and will ensure that thousands more people are helped by the Government than would have been the case without the legislation.
	This is not a theoretical far-off issue that we can put off tackling, but a real and painful issue that has affected our constituents for too many years. Hard-working people who have laboured and saved for years to afford the roof over their heads should not find that when they need care, their families are deprived of that asset. We all have constituents to whom that has happened. This is not, as some would like to pretend, a problem only for the rich. It affects everyone who owns a home and stands to lose it if the costs of their care are too great.
	Many of them are people who can afford to own a home only in retirement and many of them live in former council houses.
	It was right of the Government to commission the Dilnot review and it is right to strike the balance that Dilnot acknowledged was needed between the cost of the policy to the public purse and the desperate need for a cap. Too many homes have been sold to pay for care. It is a tragedy that Governments of all colours have failed to act sooner to address the problem. It is greatly to the credit of the coalition that it is proposing the first part of a solution. I also draw the Minister’s attention to Macmillan’s ongoing campaign for further progress on free social care at the end of life, which was mentioned by my hon. Friend the Member for Truro and Falmouth (Sarah Newton).
	Compassion is also being shown in the determination to improve the pensions of those who have spent years bringing up children, in the focus on preventing sexual violence across the world, and through tackling the impact of climate change, which will affect millions of the poorest people in the world. Compassion continues to be served by other ongoing policies of the coalition Government, such as the pupil premium, which directs funding to the most deprived pupils and helps schools to raise their attainment; the greater increase in the basic pension; and the increased investment in our NHS.
	We have heard much from Labour Members about the pressures on our NHS and Ministers are right to have acknowledged the challenges faced in A and E and urgent care, but it is absurd for the Labour party to rail against pressures that have been building for years, including under its rule, and to then implement cash cuts in NHS spending in Wales, where that party runs the Government. The South Worcestershire clinical commissioning group will receive a £7 million increase in funding this year as a result of the coalition’s policy of increasing NHS spending. By coincidence, that is the amount by which the funding of Welsh health boards is being cut this year by the Labour Administration. On a recent visit to my local hospital, I saw some of the pressures on A and E, but I also saw how the coalition’s investment had enabled the retention of more nurses and how it will soon deliver a new clinical decisions unit that will help to alleviate some of the pressures.
	We have heard much from the Labour party about the supposed privatisation of the NHS. I recently asked my local clinical commissioning group what amount of its budget goes to the private sector. Knowing that it has for some years, including under Labour, contracted certain operations, such as hip replacements, to private sector providers, I had presumed that the amount would be quite significant. I was surprised to find that the spending of the South Worcestershire clinical commissioning group in the private sector amounted to just 1.8% of its budget. That is less than its increase in spending this year. This Government are committed to efficiency and compassion in the NHS.
	Compassion and efficiency are served by the emphasis on education in the Queen’s Speech. I would like to expand on that in more detail, but fear that I do not have time. We have heard excellent speeches from my hon. Friends the Members for Lancaster and Fleetwood
	(Eric Ollerenshaw) and for South West Devon (Mr Streeter) about the funding formula in health. I merely point out to the Government that addressing the funding formula in education is equally urgent.

Jeremy Lefroy: Will my hon. Friend acknowledge that that is an issue across many parts of England, including in my county of Staffordshire?

Robin Walker: I wholly agree with my hon. Friend. I will be in Staffordshire to meet the F40 group and its executive, who are campaigning for fairer funding and a more efficient system.
	That brings me to the efficiency side of the equation. As a member of the Business, Innovation and Skills Committee, I would have liked to speak on the day of the debate that was themed on that portfolio. I regret that the Opposition chose to assign that theme to a Friday when I, like most other MPs, have many commitments in my constituency, including speaking to local businesses and schools.
	There is a great deal in the Queen’s Speech to support business and increase efficiency in Government. The employment allowance is something that I have campaigned for and it will be extremely welcome to smaller businesses and entrepreneurs as it will reduce the cost of taking people on. I would like to have seen a Bill to reform business rates and will continue to push for further such reforms. The Bill to reduce regulation on business has been called for by almost every business organisation that I have met and will be universally welcomed, as long as it works.
	The investments in infrastructure are sensible and necessary to support growth in our economy and to get Britain moving. Reducing the deficit is essential. For all the noises off that we have heard from the Opposition in this debate, they still have not got the point that the answer to a debt crisis cannot be to borrow more. When one invests, it is essential to invest well. The story of Worcester’s colleges is just one example. The previous Labour Government promised huge rebuilds costing tens of millions of pounds, but delivered nothing. This Government have delivered measured investments that have made a difference.
	It would be remiss of me, having spoken in the Back-Bench debate on an EU referendum some years ago, not to mention the amendment that has been tabled by many Back-Bench Members, which I hope will be selected for debate by the Chair. I was proud to support a motion that called for a European referendum two years ago. I welcome the fact that our Prime Minister has set out clearly that he will fight for a referendum at the next election and that he is pressing for a renegotiation of our relationship with the EU in the meantime. He was right to wield his veto, he was right to press for a reduction in the European budget, which many thought was impossible, and he is right to say that the people of this country need to be given a real choice. Like my right hon. Friend the Member for Mid Sussex (Nicholas Soames), I have every confidence that he will continue to succeed on this issue.
	I regret that some in the media have sought to build the amendment up as a criticism of the Prime Minister. It is for that reason that I did not sign it. However, I do regret that we could not include an EU referendum Bill in the Queen’s Speech, not because I believe it could
	have succeeded against the arithmetic of this House and its current composition, but because the debate would have shown how out of touch the main Opposition party is on this issue. I shall therefore support the amendment if the chance arises, and I welcome the fact that in my party at least, it will be a matter of conscience and a free vote. Although the current media frenzy is trying to paint a picture of division, I am pleased that my party is united in its determination to change our relationship with Europe for the better.
	In conclusion, it is a challenge for all Governments to balance efficiency with compassion, but for all the strains of coalition—and there are many—the coalition Government continue to govern in the national interest. Perhaps that is why, despite being mid term and despite visits in the weeks before the recent local elections from the leaders of UKIP and the Green party and the Leader of the Opposition, the party that won the greatest share of the popular vote across Worcester was none of those but the true one-nation party—the Conservative party.
	I particularly welcome the historic and long overdue decision announced in the Gracious Speech to place a cap on the cost of social care. I am honoured to have spoken in this debate and I look forward to supporting the Government as they continue to press for a fairer and more prosperous Britain.

Kate Green: It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I, too, want to talk about social care. First, however, let me reinforce the comments made by my right hon. and hon. Friends about the announcement on compensation for sufferers of mesothelioma. That devastating illness affects a number of families in my constituency, as well as many workers in Trafford Park over many decades. Work was begun by Labour on a system of compensation for asbestos-related illness where employers and insurers cannot be traced, and we now at last have a proposal from the Government although it is disappointingly limited in its reach.
	The proposed scheme will apply only to diagnoses made after 2012, and it completely misses half the victims of asbestos-related cancers because it is limited to mesothelioma sufferers and a cap is imposed on the level of payments. The deal favours insurance companies; it is not good enough for victims or for the public purse because many sufferers will continue to rely on payments from the Department for Work and Pensions as they will not be eligible for the compensation scheme. Although the proposals in the Queen’s Speech for a system of compensation are welcome, I hope we will be able to improve the legislation as the Mesothelioma Bill passes through the House.
	On social care, everyone agrees that people would prefer to be cared for in their own home for as long as possible, but community-based provision must be in place for that to happen. As many right hon. and hon. Members have said, a lack of community provision is placing excessive strain on the NHS with regard to A and E and bed blocking, and my local authority in Trafford has received repeated reports that a lack of access to rehabilitation, physiotherapy, speech and language therapies—for example, after a stroke—and to support and care packages means that it is often impossible to
	discharge someone, even when they are medically fit to go home. That backdrop is of particular concern at a time when a significant reconfiguration of our national health service is being proposed in Trafford. There must be real concern about a squeeze on NHS services when community provision is not in place.
	I am pleased that the Secretary of State has recognised the need for a single named professional to have oversight of an individual’s health and social care needs, but the fragmentation and contracting of NHS services does not help. Competition works against the integration of primary, secondary, tertiary and social care and, as many colleagues have said, cuts to local authority budgets are having a massive effect. Trafford is cutting nearly £3 million this year from social care budgets, which means cuts to day services, for example, or increased costs for meals. Curiously, the local authority intends to achieve a large part of those savings through the introduction of personalised budgets, which we understood were not intended as a savings measure.
	Families want to help and keep loved ones at home, but they are under great pressure and rely particularly on day services and respite care. They tell me that assembling a personal package is complex. One constituent —a highly resourceful and articulate businessman—told me of his struggle to use a personalised budget to assemble a care package for his partner. He called seven potential providers, but most could not cope with assembling the package she needed to meet her complex needs. If my constituent could not put together that package, how—as he rightly asked me—will the more marginalised and excluded manage? He pointed to the importance of decent brokerage services, yet at the same time we are seeing cuts to advocacy services. There is already evidence that personalised budgets do not work so well for elderly people or those without family and friends to help.
	It is not clear what the long-term effects of spreading personal budgets will be, but they could lead to further fragmentation of services or exacerbate inequalities. For example, there is evidence of a lack of cultural awareness among brokers and providers, and the complexity of putting together a personal care package may leave the most excluded even further behind. I invite Ministers to tell the House what steps they will take to monitor the impact of personal budgets on inequality and outcomes for the elderly and most vulnerable.

Norman Lamb: rose—

Kate Green: I am pleased the Minister is seeking to intervene.

Norman Lamb: Does the hon. Lady accept that there has sometimes also been a lack of cultural awareness in the traditional way of delivering services when people make assumptions about someone’s care needs and the right way to deliver them? Putting the individual in charge and letting them determine their priorities gives us a better chance of getting it right and meeting the cultural choices that are so important to people.

Kate Green: I accept what the Minister is saying but evidence suggests that for certain more disadvantaged and vulnerable individuals, articulating those needs is very difficult and so culturally appropriate advocacy, representation and brokerage services will be of huge
	significance. Evidence from research carried out so far suggests that the effects of personal budgets are patchy. I am sure the Minister will wish to raise standards across the board, and I look forward to the further work that we—collectively and with local authority colleagues—can do to ensure that that is the case.
	Work force issues relating to social care are also a concern. As others have pointed out, many of those working in social care earn the national minimum wage and contract pressures mean that they have little time to do more than rush in and out of appointments and provide the basic physical care that clients need. There is little time to stop for a chat or a cup of tea, or for some of the social interaction that is so valued by those in receipt of social care. Many providers have told me they are anxious and that they are being screwed down on pricing as a result of local authority spending pressures, which could lead to their contracts becoming unviable. Poor levels of pay— as my hon. Friend the Member for Bridgend (Mrs Moon) said, staff are often not paid as they move from one appointment to the next—mean that they will not be motivated to provide the best care in those circumstances, and some will be forced to give up their jobs.
	Finally, I welcome the development of extra care for those in need of residential care, and some good projects are under development in Trafford. I hope the proposed development in Old Trafford will receive approval. As colleagues have pointed out, the Dilnot recommendations, as taken forward in a more limited form by the Government, will leave many families in my constituency with substantial costs but without liquid savings with which to meet them, meaning they are still likely to be forced to consider the sale of the family home.
	Overall, the Queen’s Speech needed a much bolder approach to prepare us for an ageing society, including policies for maximising saving in working age—difficult when the Government are putting family budgets under such pressure—and a bolder approach that looks at combining health and social care budgets, investment in primary and community health provision to keep people out of hospital longer, integration over competition, personalisation accompanied by a service investment programme, and serious attention to work force development. I regret the many missed opportunities in those areas in the Queen’s Speech.

Stephen Mosley: We are now three years into the coalition Government and there is much that we can be proud of—health, welfare, police and education reforms; this has been one of the most radical Governments in a generation, but there is still much to do. It is not only about ensuring that our country is on the right economic track; the British people must know that the Government are on their side.
	Recent local elections have shown that a sizeable minority are disaffected, disillusioned and dismayed by politicians and political parties, and the Prime Minister, Deputy Prime Minister and Leader of the Opposition have been bombarded with advice, often from their own Back Benchers. Often—surprise, surprise—the advice from those Back Benchers seems to be that the only way we can re-engage the trust of the electorate is by taking over their pet project. My advice to my party leader is
	that there is no magic bullet to winning over the electorate. Voters are cynical and fed up of political spin. They will spot a phoney a mile off. My right hon. Friend should be himself, be natural and not pretend to be something he is not. He should be proud of what we have achieved.
	Things can sometimes be difficult in a coalition. Compromises need to be made. Sometimes our friends in the Liberal Democrats have had to make compromises; sometimes Conservatives have had to do so. However, at long last, Britain is moving in the right direction again. I urge the Government to hold their nerve, do what they believe to be right and ignore the siren voices calling for a change of direction. Some in the Chamber shout loudly, but that does not mean they are right, or that they have the support of the majority of their colleagues.
	The Government should stay calm, because the foundations of future prosperity have been laid in the past three years, but we must not be complacent. The measures announced in the Queen’s Speech are another step on the journey to national recovery. I am particularly pleased that the Queen’s Speech tackles head-on two tricky problems that were classified as too difficult to touch by the previous Government. Both problems—reform of social care and reform of pensions—involve helping people in their old age.
	Twenty years ago, Britain had the best pensions provision in Europe. Our pensions savings were the envy of the world. Millions of workers were signed up to excellent final salary pension schemes. Schemes were in surplus, and workers could look forward to retirement with a good, inflation-proof income. All that changed in 1997. The scrapping of advance corporation tax relief blew a massive hole in the value of pension schemes. That measure cost more than £5 billion a year—it has now cost pension schemes more than £100 billion, and the average worker has lost around £100,000.
	Labour’s raid on pensions was just one nail in the coffin of final salary pension schemes. People are living much longer, and the global recession, the turmoil in the eurozone and our massive deficit have not helped matters—they have resulted in historically low interest rates, meaning that pensioners get less income from their savings.
	Reform is urgently needed, which is why I warmly welcome the inclusion of the pensions Bill in the Queen’s Speech and the introduction of the single-tier pension. To ensure that future pensions remain affordable, people will have to work a year or two longer, so the Bill will bring forward the increase in the state retirement age and introduce a five-yearly independent review to ensure that the state pension remains sustainable. The current pension system is complex and confusing. It is almost impossible for people to work out how much they will receive. Under the new single-tier pension, people will qualify for the full pension of £144 a week provided they have made 35 years of national insurance contributions. Millions of future pensioners will be removed from poverty, and people who have saved for retirement will be able to enjoy the full benefit of their savings.
	The proposals will address the inequalities in the current pension system. The Bill will support women who have taken time out to raise a family, and support low earners. The national insurance contributions of the self-employed will count towards a pension for the first time. Future generations will also benefit from the option of a workplace pension, with a contribution
	from both their employer and the Government. The pensions Bill will provide a clear, straightforward and fair pension for all—one that is secure as we face the problem of an ageing population.
	Another big worry for people as they get older is who will look after them in their old age. The cost of care can be astronomical. For many, the fear of running out of money or being forced to sell their home to pay care charges causes huge concern. It is only natural for people to want to leave something behind for their children and grandchildren, and only natural that, after a lifetime of working hard and paying taxes, people want and expect the Government to be there to help. I therefore warmly welcome the announcement of the social care Bill and the reforms to long-term care funding. A cap on social care costs will help to ensure that the elderly do not have to sell their homes to meet their care bills, and that old people do not feel that they are a burden on others as their lives draw to a close.
	The Bill will make a great deal many other improvements to the social care system, such as standardised thresholds for determining whether individuals are eligible to support from a local authority. It will include a duty on councils to inform residents about care provision, and a new right for carers to receive more support. For too long, Governments have found the problems of social care too difficult to tackle, and consequently tried to ignore them. I am proud that this Government are tackling the problem head-on and proposing a long-term solution that will benefit millions.
	I warmly welcome the Government’s programme outlined in the Queen’s Speech. We have begun the long and hard process of restoring our nation’s finances to order. We must now turn to strengthening our society. We have achieved a massive amount in the past two Sessions of this Parliament, but a great deal more needs to be done. This year’s Queen’s Speech is an excellent step in the right direction.

Dan Jarvis: I am grateful for the opportunity to contribute to the Queen’s Speech debate on health and social care. Protecting the health of young people, reducing preventable deaths and safeguarding the health of Britain’s population are three important goals, but the absence of a Bill to introduce plain packaging for cigarettes undermines the Government’s commitment to those goals.
	Cancer is an illness that touches many people’s lives. Although research is key to finding new ways to treat cancer, the Government can take simple and practical measures to avoid preventable deaths. Last week, the Government failed to introduce one such measure that could help to reduce cancer and other forms of smoking-related disease.
	The introduction of standardised, plain packaging had been heralded as a good idea by a number of members of the Government. The Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), a member of the medical profession, had previously shown his support for plain packaging. He said that plain packaging
	“could certainly help to reduce the brand marketing appeal of cigarettes to teenagers, and most importantly, help to stop young people from developing a smoking habit that can only shorten their lives.”
	I agree with him. The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), has stated that the evidence she has
	“seen suggests that it is the attractiveness of the packets that leads young people to decide to take up smoking.”—[Official Report, 16 April 2013; Vol. 156, c. 561.]
	I agree with her, too, and yet, three years into this Parliament, no action has been taken by the Government.
	According to Cancer Research UK, more than 100,000 deaths are caused by tobacco each year in the UK. That could be much reduced if the Government took meaningful action. Between 2006 and 2007, the Labour Government took action to curb the harmful effects of smoking by banning smoking in public places. As the shadow Secretary of State for Health has said, the introduction of plain packaging for cigarettes is a natural progression, and as the Leader of the Opposition said in his response to the Queen’s Speech, plain packaging is the right thing for public health and the right thing for the country. I agree with him.
	Since the Government consultation on plain packaging closed some nine months ago in August 2012, more than 150,000 children will have started an addiction to a substance that results in the death of half its long-term users. I accept that the introduction of plain packaging is not a silver bullet, but neither is it the nanny state, as some have described it. Plain packaging is a means of preventing young people from taking up a habit that, in the long run, could cost them their lives. Some 257,000 11 to 15-year-olds become smokers each year, and that number is unacceptable. We already have legislation to prevent children below the age of 18 from buying cigarettes. We banned smoking in public places, but more needs to be done.

Madeleine Moon: The allegation is that it would be a nanny state if we introduced plain packaging. Is that not a contradiction, given that we know that state intervention often saves lives? If we had been worried about the nanny state, we would never have introduced seat belts or drink-driving laws, yet we would never move back from those. Is it not time we moved forward on plain packaging as well?

Dan Jarvis: I completely agree. The term “nanny state” has been used, but we want to prevent young people from taking up a habit that in the long term could cost them their lives. In 2013, Labour Members are on the correct side of the debate, which is also where the public are.
	We should pause to consider the financial costs of smoking, which can be seen in its impact in towns such as the one I am proud to represent. The financial costs encompass much more than heightened NHS expenses; lost output and lost productivity both increase the price associated with smoking. For Barnsley alone, smoking creates a bill amounting to £75.3 million each year.
	Yet the financial cost is small compared with the human cost. In Barnsley, there are 485 adult deaths from smoking each year. Despite that, nearly 1,000 children in Barnsley aged between 11 and 15 take up smoking each year and approximately 1,100 10 to 14-year-olds there are regular smokers. Like the rest of the UK, Barnsley has paid too high a price. It is time that action was taken to prevent the costs of smoking from stretching further and further into the future.
	Let us be clear: advertising works. If it did not, the tobacco industry would not spend such vast amounts of time, money and effort on packaging presentation and it would not be opposing plain packaging with such vigour. For the tobacco industry, packaging is a form of advertising that helps to keep existing customers loyal and attracts new ones. On that point, the World Health Organisation is clear:
	“Marketing of tobacco products encourages current smokers to smoke more, decreases their motivation to quit, and urges”
	young people to start.
	Of course children will be attracted to sophisticated and glamorous packaging. When he was Health Secretary, the Leader of the House echoed that view, stating:
	“It’s wrong that children are being attracted to smoke by glitzy designs on packets…children should be protected from the start.”
	Unusually, I agree with him.
	A lack of evidence cannot be used as an excuse for delaying the essential legislation. Advertising does impact on young people’s decisions, and in the context of smoking that means that children’s health is put at risk. The trade-off between the tobacco industry and children’s health has been in favour of the industry for too long. It is time that something was done to redress the balance.
	There is also clear support for plain packaging from the public. Last year, 63% of the UK public supported standardised, plain packaging and only 16% of people opposed it. A lack of public support is not holding the Government back from introducing the legislation; in fact, 85% of people back Government action to reduce the number of young people who start smoking.
	By delaying the next step in smoking prevention, the Government are not only putting a future generation’s health at risk, but ignoring a key issue that British people want and need Parliament to address. There is the evidence, the public support and the moral imperative to act, yet the Government have so far failed to take the definitive action needed to save lives, reduce health care costs and prevent children’s health from being put at risk.
	Madam Deputy Speaker, please accept my apologies for not being able to attend the winding-up speeches. Let me conclude by saying that I am in no doubt that plain packaging is the right thing for public health and the right thing for the country. I am in no doubt we will have plain packaging. When we get there, we will wonder why it took so long to protect children against the harmful impacts of smoking and about the lives that could have been saved if we had acted sooner. We can stop that wondering if we act sooner rather than later. We know that advertising works and that smoking kills. It is time to do something about it.

Jeremy Lefroy: It is an honour to follow the hon. Member for Barnsley Central (Dan Jarvis), with whom I entirely agree about standardised packaging for cigarettes. I also agree with those who have spoken in favour of a minimum price for alcohol on public health grounds.
	The Gracious Speech contains many important measures that are likely to assist the economy in my constituency—not least the employment allowance, the reduction of the burden of excessive regulation and measures to make it
	easier to protect intellectual property. Unemployment has fallen in my constituency since the election, but there is still a great deal to do. The number of apprenticeships has risen, so I welcome the Government’s plans to ensure that it becomes
	“typical for those leaving school to start a traineeship or an apprenticeship, or to go to university.”
	As previous speakers have said, the Government are taking important long-term decisions on the financing of pensions and certain parts of social care. Those decisions, including the change in the state pension age, the introduction of a flat-rate pension and the capping of care home costs, aim to give more certainty in an increasingly uncertain world, and I shall return to that.
	I shall be opposing one measure, I am afraid—the plan for High Speed 2. It is my belief and that of my constituents that both the concept and the business case are deeply flawed. My constituents cannot understand why a route is announced 13 years before work starts without a proper plan to compensate immediately those whose property has been rendered unsellable. I have visited and heard from constituents who must, for pressing personal reasons, move house now, but who simply cannot. I urge the Government to put in place a full, fair and speedy system of compensation or purchase of property to enable those constituents to carry on with their lives.
	I now wish to concentrate on health and social care. First, I ask the Government to provide time for a full debate on the Francis report into the Mid Staffs NHS Foundation Trust. Important lessons have already been learned. The appointment of a dedicated inspectorate of hospitals is a major step—unusually, I must disagree with the hon. Member for Walsall South (Valerie Vaz)— as is the introduction of more practical teaching into nursing training.
	However, there is much more in the Francis report that needs to be debated. The vital and important work that Julie Bailey and Cure the NHS did to highlight problems in care deserves a thorough hearing. Earlier, we were all moved by the speech made by the right hon. Member for Cynon Valley (Ann Clwyd), who is looking into the matter and takes it so seriously. We also need to look at how mortality statistics are compiled and used, as they are becoming important and controversial.
	Secondly, I spoke about the importance of trying to give some certainty on basic needs in an uncertain world. That applies to health as much as to pensions and social care. The provision of a national health service free at the point of need probably provides more peace of mind to the people of this country than any other single thing that a Government could do, apart from ensuring security, law and order.
	Health care affects each of us and does so, in different ways, throughout our lives. It is a common bond between us and contributes to social cohesion. Yet its long-term financing is on difficult ground. The Government have rightly protected NHS spending at a time when other budgets have had to be cut, but with a growing and ageing population, it is likely that we will need a real-terms increase in spending in the coming years.
	There is little room to cut costs from other Departments. We have to find another way to allow controlled, efficient and effective increases in health and social care spending, to deal with the challenges posed by an ageing population while not cutting other essential public services. I encourage
	the Government, over a period of years, to look at turning national insurance into a national health insurance that, as now, is based progressively on personal income, and which will provide the funding for health and, eventually, social care. That would enable us to have a sensible discussion on the national insurance rate required to fund health and social care properly, separate from the wider debate on tax rates and tax policy.
	Thirdly, I wish to raise again the question of emergency and acute tariffs, on which my hon. Friend the Member for South West Devon (Mr Streeter) spoke so eloquently. The continuing squeeze on them, coupled with the fact that activity greater than 2009 levels is paid at only 30% of the full tariff, is leading inexorably to financial difficulties for acute hospitals, particularly district general hospitals such as mine at Stafford. However, it is not only the smallest that are affected. Major trusts also face deficits. Even if they are not, they will have to pick up the work load if acute services are removed from their smaller neighbours. That situation cannot continue. The drift towards centralising all emergency and acute services in the largest hospitals has to be stopped—even reversed. It will mean much closer working between hospitals, as hon. Members have said, and perhaps the end of many smaller trusts, though not smaller hospitals. It will also mean that royal colleges will have to get a grip and stop the fragmentation of health care into more and more specialties that cover less and less. We need, as the head of a medical school said to me recently, to rediscover the importance of high-quality generalists. A publicly funded national health service can only survive on that basis. That does not mean that specialisms have no place in the NHS—of course they do—but they must not drive out good general medicine.
	Fourthly, the Government need urgently to look at health allocations across the country, as my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) said. The welcome increase in public health funding where there are particular inequalities was meant to enable per head allocations to become fairer, but that has not happened. Currently, South Staffordshire receives at least £40 million per year below its recognised fair shares allocation, and that is making the work of local clinical commissioning groups even harder. The Government have committed themselves to addressing this, but it needs to be done this year or CCGs will find themselves in a very difficult position right from the outset.
	Finally, it is vital that the Government listen to the public. On 20 April, it is estimated that 50,000 local people went on a local march and rally, which I had the honour of addressing, in support of Stafford hospital. They were speaking out against the idea that emergency, acute and maternity services could be removed, and were making the point that alternative services were too far away and, in any case, themselves under great pressure, and that the proposals did not take proper account of the increasing population and demography. All of that is common sense, and I hope that the administrators currently running Stafford and Cannock hospitals listen to that common sense, and that it is heard across the country.
	Monitor has a chance, together with the trust development authority, to establish a sensible and long-lasting configuration for emergency and acute hospital services across the country that recognises the important role of our smaller, acute district general hospitals. That
	can be done and it must be done. The Government are tackling the long-term problems on pensions that we need to take on, and it is vital that we do the same for health and social care.

John Woodcock: It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who made a thoughtful and considered speech on an issue of great importance nationally, as well as to his constituents.
	It was a pleasure to be in the Chamber to hear such a powerful speech on plain packaging for cigarettes from my hon. Friend the Member for Barnsley Central (Dan Jarvis). Frankly, if Ministers are not convinced after hearing his arguments, they should probably not be in their place. I think that they are convinced and I hope to see them make progress.
	I want to start on a note of consensus. I welcome the inclusion in the Gracious Speech of the Bill on mesothelioma compensation. This dreadful disease is a time bomb that, once detonated, often goes on to kill within months. With its shipbuilding heritage, more individuals in Barrow and Furness suffer from mesothelioma than in any other constituency in England. We owe a duty of care to all those who are suffering: they made an honest living and what is happening to them is not right. We should applaud all those who have pushed for further progress, including former Labour Ministers and the hon. Member for Chatham and Aylesford (Tracey Crouch), who I understand wanted to be here but is on her sick bed.
	There are early concerns about the Government’s paucity of ambition. It is vital that the Government mandate a scheme that will build fittingly on the work of my predecessor, Lord Hutton, who expanded and speeded up compensation in the previous Parliament. However, many will see the thin programme last week as a missed opportunity to address increasing alarm about the Government’s poor stewardship of the NHS. It would be too optimistic to hope that Ministers have had an early change of heart on the costly and ill-conceived reforms they have just bulldozed through Parliament. In addition to the lamentable absence of plain packaging legislation, they could have introduced measures that sought to bridge the yawning gap between their rhetoric on listening to local people and the reality that is seeing the clear wishes of residents on NHS services ignored up and down the country.
	In Barrow and Furness, we hope that health professionals in charge of provision across Morecambe bay will heed the passion and powerful arguments from local people on oncology, maternity, and accident and emergency provision. While residents understand that it can make sense to travel to get the best that 21st century health care can offer, like so many across the country they love their local hospital, they think it should have its fair share of the very best, and they think local provision, that is accessible to them and visiting loved ones, is a basic part of a quality service, not something to be dismissed as an unnecessary luxury.
	I have some hope that the new management team at Morecambe Bay NHS Foundation Trust will listen to local concerns. An early test will be the publication of revised plans for Furness General hospital’s oncology unit this month. However, we see what is happening in
	other areas where the Government’s local engagement test is proving to mean little more than holding a meeting and nodding in an understanding manner, and ignoring everything people say and downgrading services anyway. When my constituents they see the scale of the upheaval and cuts to front-line nursing staff involved in reducing the budget of Morecambe Bay trust by £25 million within two years, they are, understandably, very wary of trusting Government promises that no efficiency savings will be allowed to affect the quality of patient care. I hope the Minister will tell me whether the Government will heed calls, including from the trust itself, for a rethink on the speed and scale of the cuts they are imposing.
	Will the Government not take heed of the dismay felt about recent NHS reorganisations and enact measures to strengthen the power of local opinion in determining the future of our hospitals? We live in times of strained resources, but faith in the future of the NHS may continue to be eroded until we learn genuinely to trust local communities. When we come to look back at the history of the NHS over the current decade, I think we will see this as the time when we were bound overly tightly to the idea that the clinician always knows best. We will come to see the Government’s blind faith in the clinical stamp for taking services away as an early 21st century equivalent of the “Whitehall knows best” mentality that gripped reforming Governments after the second world war. Just like the “Whitehall knows best” ethos of the 1940s and 1950s, the clinician knows best mantra has the best of intentions but is insufficiently responsive to challenge from the patients who rely on the services that are being shaped by those at the centre.
	Let me be clear. It is essential that health professionals make their case when decisions are made. Their expertise is immense and people should not deviate lightly from their plans. However, it is by no means certain that any one group, even one bursting with medical experience, will always call it right first time. Their views must be subject to scrutiny. Often the clinical push to concentrate a specialism at a single site takes less account of local geography and community links to health facilities than is demanded by local people, who ultimately pay the clinicians’ wages.
	This is not an argument for sentimentality. The views of local people will sometimes be irreconcilably different in a single area, but if, for example, Barrow families suddenly face the prospect of a 100-mile roundtrip to visit a relative—because a unit at Furness General hospital has moved to Lancaster—their views on the move will be important. Many communities across England are fighting for their local health services. Some are threatened by cuts, but others are at risk from this clinically led decision-making model.

James Duddridge: The hon. Gentleman is making some valid points, several of which I am deeply sympathetic to, but on clinicians, is he referring to GPs or specialists? Does he think that the clinical commissioning groups of GPs who are more fixed in the community could have an impact on, for example, oncology and other specialisms in local hospitals?

John Woodcock: That is a good point, and it remains to be seen. We hope so, but the system has yet to be put to the test.
	I am disappointed that no move towards genuine localism was outlined in the Gracious Speech. It is time for a people’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto that ought to be heeded. That would require a step change in our NHS away from a model that, yes, might have helped deliver improvements in health outcomes of which the country should be proud, but which has done so—

Norman Lamb: Will the hon. Gentleman give way?

John Woodcock: I will give way, if the Minister is quick, because I do not have much time left.

Norman Lamb: I am interested in what the hon. Gentleman is saying, and I accept the point about the importance of accountability. [Interruption.] He has just realised that he has got an extra minute of time, so I have done him a favour. Does he accept, however, that the old NHS, which we reformed, had no local accountability at all and that we have introduced some accountability through the health and wellbeing boards, bringing together local authorities and the NHS?

John Woodcock: It is an interesting point. I am not claiming that the system operating now is fundamentally different from that of three years ago, but around the country people who were promised a say in local decisions have been devastated to find out that they have none. Unquestionably, what has been put in place is not adequate. It is a sop to localism that does not do what it says. It would be a step change to move away from the current model.
	Following the current model has meant alienating many local people who understood the trade-offs, but nevertheless fervently desired to keep services local. Whatever happens, surely the current tension between national planning and local unrest is unsustainable in the long term. In opposition, the Conservative party told the public that it understood that and pledged to end local hospital service closures, but of course its promises turned out to be a cheap election con trick. Instead, Ministers have forced through an expensive, chaotic and divisive health reform package that ultimately has pushed NHS decision making still further from the people it serves. We need a change of direction. Local communities pay for the health service they receive, and they deserve to be treated with greater respect.

Paul Maynard: It is a pleasure to speak in this section of the debate on the Queen’s Speech.
	It is three years, almost to the day, since I made my maiden speech, in the very same section of the debate on the Queen’s Speech—health and social care—and a lot has changed in those three years, especially on the Government Benches, in terms of policy. Listening to the Opposition speeches, however, and indeed to some from the Government Benches, it seemed to me that a lot had not changed. I think back to 1997, when the Conservative party experienced an appalling and traumatic defeat. How did it react? For a short while, we thought that the voters had got it wrong, that we could keep
	thrashing away at the same old themes and that very soon the voters would repent of their folly and everything would be all right, we would be carried back, shoulder high, into power. Of course, it did not happen; it took us 13 years and three election defeats to realise that singing the same old tune, time and time again, did not deliver the promised nirvana.
	When I listen to Opposition Members, I feel as if I am listening to the Conservative party of 1997, only now it is the Labour party of 2013: unwilling to change, going back to what makes it feel comfortable, bashing the tobacco companies—perhaps quite rightly, but there needs to be a much stronger evidence base than disliking global capital, for heaven’s sake! Time and again, I listen to Labour Members and think, “Theirs is not a party that is ready for power”, because I am not hearing a new analysis or new arguments; I am just hearing the same old grudges, although I might except the hon. Member for Barrow and Furness (John Woodcock), who is one of Labour’s more thoughtful Members—that is quite rare on the Labour Benches.
	I was delighted to have the Leader of the Opposition in Cleveleys for the local election campaign. On this occasion, he kindly wrote to tell me in advance—the first time he had done that, despite having made several visits—so I thank him for that small courtesy, if for nothing else. He gathered in the shopping centre in the centre of Cleveleys, with his little pallet, which he stepped on to. Labour bussed in all the councillors it could from Blackpool, because there are hardly any Labour activists in Cleveleys, and he just stood around, and my spy, who was there, tells me that no one paid him the slightest attention—he was looked upon as rather a curiosity, while people walked by eager to get on with their shopping and get their bargains. What happened? The political compass needle in Cleveleys barely shifted compared with 2009. If Labour cannot win back Lancashire—a county it controlled from 1981 to 2009—it is not in a position to gain power, in my view. That is why it is doubly important that Conservative Members do not get overly seduced by what UKIP is doing, but focus on what matters and what we were elected to do.
	In my maiden speech three years ago, I stressed the importance of the dignity of patients in our health care system, and I have stressed it ever since. We are now starting to see progress on that, not least thanks to the activism of the right hon. Member for Cynon Valley (Ann Clwyd) and the role she now plays, but more importantly thanks to the rhetoric around what we recognise as being important. On my way here today from Euston, I was standing on an underground train behind a young trainee nurse. In her arms was a thick folder bearing one title: “dignity”. That message is starting to get through to NHS staff, in particular.
	Although we can all recite cases from constituents of cases of care that they felt were below standards, we must balance that with the recognition that nurses are the glue that holds the NHS together and that we talk them down at our peril. For every nurse who might not have ensured that somebody was adequately fed or had their fingernails clipped or their conversation in the morning, there is another for whom nursing is a vocation. We have to recognise that. Nursing is a vocation. Occasionally, it is a very difficult vocation. The system can be testing, trying and infuriating for many, but nurses are there because they want to care for their patients.
	Perhaps the secret to health policy lies in allowing our health care professionals to express that vocation, not to smother it beneath a system that does not allow that feeling of good will and desire to do good for our fellow patients to express itself.
	The other thematic issue I want to come to is perhaps a little more controversial. We are all politicians, are we not, whether we like it or not? I am sure I would rather not be a politician, but I am a Member of Parliament and it comes with the territory. The moment anything is scheduled to close in our constituencies, there is an immense temptation to man the proverbial barricades. We issue a press release and set up a photo op outside the threatened location, but do we always pause to think what is in the best interests of our constituents, or do we think, “What will get me more votes?”?
	I am fortunate, as I have an excellent hospital in Blackpool, the Victoria. It has one of the premier stroke rehabilitation units in the north-west. When it opened, it started taking in-patients from as far away as the south lakes. I am not quite sure, but the area it covers might even stretch as far as Barrow—I know it goes as far as Kendal. That was quite controversial at the time, because it meant that a patient having a stroke would have to drive past about four hospitals to get to Blackpool. Some people thought, “Why can’t we go to our local hospital? It’s got wonderful facilities.” However, since the stroke unit at Blackpool opened, survival rates have increased for all patients in all groups, because of the excellence of its specialist care. That is a challenge for every Member of this House, no matter what our political parties. The easy answer—the easy campaign, the scare story, or what I call “campaigning in the conditional”—is not always in our long-term interests.
	I ask myself how I would have reacted if the stroke unit had been in Lancaster rather than Blackpool. Would I have manned a barricade, gone on a march or set up a petition? I do not know; I hope I would not. I hope I would have trusted in the idea of outcomes. Although I recognise what the hon. Member for Barrow and Furness (John Woodcock) said about localism needing to mean something, I also recognise that clinicians, too, have a role. Where outcomes are unacceptably poor, something has to be done. However, we need to do a much better job of communicating to our electorate why the clinical evidence that suggests that a particular thing has to change is powerful evidence, because evidence is power and we need to convince those who are most concerned.

Madeleine Moon: There are approximately 6 million carers in the UK, 2.2 million of whom provide more than 20 hours of care a week. Between them, they provide more than £119 billion worth of care each year. They are listening to this evening’s debate. They want to know whether what is in the Queen’s Speech is empty words and further promises, or whether their lives will improve and changes will be made.
	A lot of people have spoken of the work undertaken by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in the complaints review. I have sent copies of the letters I wrote when I made a complaint about the absolutely appalling treatment of my mother in an English hospital over a number of visits. I worked
	hard to make the complaint stick and ensure that my voice as her carer was heard, but even I, as a Member of Parliament, was worn down in the end.
	I have sat in this debate and listened to Government Members criticise the Welsh health service. I have a very sick husband. He uses the Welsh health service, and I am grateful for the quality of care that he receives from it every day of the week. I know that my GP service is excellent and I know that if I need care from my local hospital for him, it is there, so I want to hear no more nonsense about the Welsh health service.

John Glen: Will the hon. Lady give way?

Madeleine Moon: No, I will not; I am in the midst of my speech.
	In Bridgend, there are 18,000 people providing care for relatives or friends. Some 5,500 of them provide unpaid care for more than 50 hours a week—care that is compassionate and dedicated; care of a quality that we would love to hear is being provided in our hospitals. I asked a group of carers recently what it meant to be a carer. One of them said, “It’s like trying to live two people’s lives and cramming them into one person’s life.” The other said, “You’re an expert in bodily fluids. Urine, faeces, blood and vomit are the daily recipe.” Is it any wonder that the Royal College of General Practitioners recommended last week that all carers should be screened for depression? It recognises that carers are particularly susceptible to depression and that there is a need for greater support.
	Carers UK has reported that almost a third of those caring for 35 hours a week or more receive no practical support, while 84% of carers surveyed said that caring had a negative impact on health. That is up from 74% in 2011-12, so the problem is getting worse. Four in 10 —42%—of those caring for someone discharged from hospital in the last year felt that the person they were caring for was not ready to come out of hospital and that they did not have the right support at home. I worked in discharge care in a number of hospitals in Wales. Safe discharge was a major platform on which we worked. The things that are a problem remain the same. There is a lack of specialist equipment readily available for carers to assist with discharge—I am talking about beds that prevent bed sores, hoists, commodes, adapted bathrooms, swallowing assessments, speech and language therapy, occupational therapists and physios. It is not just nursing we need to focus on; it is all those important services.
	We also need to look at the availability of treatment and medication that make a difference to people’s lives. I want to talk briefly about a condition that really shocks me and the carers of those who have it: aHUS, or atypical hemolytic uremic syndrome. I am the co-chair of the all-party kidney group. A few weeks ago I chaired a meeting of people with aHUS. There is a drug available for the condition that is called—excuse me, Madam Deputy Speaker, but it is a dreadful drug to pronounce—eculizumab. It sounds like some sort of African tribe, but that is what it is called. Taking eculizumab can virtually cure someone with aHUS. They get their life back. We are talking about a very small number of people who have the condition—less than 170. The typical form is triggered by a bacterial infection such as E. coli; the
	atypical form is genetic. We heard tragic evidence from families in which perhaps three or four generations of children and adults carried the genetic trigger. More importantly, the only treatment other than taking eculizumab is to have dialysis on a virtually daily basis. We heard from carers who have to place the extremely painful and long needles needed for dialysis into their children’s arms. Those children cannot have a kidney transplant because the transplant would almost certainly have the same condition. Even if they had a transplant, they would continue to need dialysis.
	I am appalled to learn that the Government have agreed that those who are taking the drug on a trial basis may continue to take it, while those who have already been diagnosed but refused access to the drug on a trial basis will not be allowed access to it. Newly diagnosed patients will, however, have access to it. That is nonsense. We could save a large amount of money, and we could save those patients the trauma of daily dialysis. The drug was recommended for use by the Advisory Group for National Specialised Services and it has now been submitted to the National Institute for Health and Clinical Excellence for further appraisal. Sufferers of the condition might therefore have to wait until 2014 to get access to it, which is totally unacceptable.
	Madam Deputy Speaker, I am sorry that I shall not be able to stay for the winding-up speeches, but I hope that the Minister will consider whether it might be possible for access to this drug to be extended to all sufferers of aHUS, so that they and their carers can once more have a decent quality of life, and so that the NHS can save money.

James Duddridge: It is a privilege to be called to speak in the debate, and it is good to follow the hon. Member for Bridgend (Mrs Moon). Some of her comments about rare kidney diseases resonated with me, as I have recently visited the very good renal centre in Southend. I have also looked into the issue of rare diseases. Individually, they might be rare, but collectively they are quite common as a group, and the funding for the relevant drugs and for more general treatment can be tricky.
	I have a quite carefully drafted speech here, but I was blown away by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who spoke without notes and whose speech was a fantastic tour de force. I am tempted, perhaps unwisely, to pick up on a number of issues that have been mentioned in the debate, some of which have been quite controversial. I did not listen to every single speech today; I missed half an hour. While I nipped out for a cup of tea, I heard colleagues on this side of the House speaking out against equal marriage—perhaps some Opposition Members did so as well—but I for one am glad that that legislation will be dealt with in this Session. The carry-over motion will ensure that we have ample time to debate it and to work through some of the issues. In 20 or 30 years, we will look back in confusion as to what the problem was. We are perhaps introducing the legislation faster than the public has an appetite for, but politicians sometimes need to lead rather than follow.
	At lunchtime today, I had the privilege of having lunch with my mum and dad, who were in very good form. They said that they had been looking for me
	during the Queen’s Speech but had been unable to see me, and I told them that the debate was carrying on today. I asked them what they had thought of the speech, and they told me they thought it was very funny. I am not sure that either Her Majesty or the Prime Minister wanted to create that impression. I asked my mum why she found it funny, and she described how Black Rod had got stuck halfway down and been held up by the Speaker.
	There has been a debate today about whether the Queen’s Speech was too narrow. The right hon. Member for Rother Valley (Mr Barron) criticised Conservative Members for talking more about what was not in the speech, but the general public do not think in terms of Bills and Acts; they think in themes, as my hon. Friend the Member for Blackpool North and Cleveleys said. One theme of today’s debate has been immigration seen through the prism of the NHS, although the general public probably also look at it through other prisms, including housing and Europe. Looking at the Queen’s Speech in a thematic way is perhaps slightly more useful.
	I am tempted to make some comments on Europe. It is constructive that we should vote on the matter. If the coalition is to survive, it will need to be more comfortable about having open debates rather than simply private ones. We will need to have more open debates, rather than fewer, if the coalition is to be healthy all the way through to 2015. It is a strength of democracy to have open debate rather than narrowly commit ourselves to certain lines.
	On immigration, the right hon. Member for Rother Valley talked about the use of extremist language. Actually, far from its use being negative in this context, the use of immoderate language can sometimes be essential if we are to have an open discussion. Otherwise, the debate gets overtaken by the Daily Mail and the Daily Express. We should have a full and frank debate on immigration, and on other issues.
	When we consider health—the main focus of today’s debate—I think politicians are sometimes too scared to ask questions about a merger or a closure, for example, and to query whether those are the right things to do. We should be more open minded. The hon. Member for Barrow and Furness (John Woodcock) said that more local people should be involved in the process. I am sure he is right, but I am not sure that that is a totally new thing, as the Minister intervened to say in the latter part of his speech. I was certainly very close to the position the hon. Gentleman stated. I am not sure which of us should worry more about that, but it is a statement of fact about how I felt.
	The commitment to spending 0.7% of gross national income on international aid was not in the Queen’s Speech. That is a totally arbitrary figure, but it is a promise that all the main political parties made and one that I fully support. To be frank, I cannot get het up about whether or not the commitment is built into a piece of legislation. If my family was starving in Ethiopia, or in the northern badlands as Bob Geldof would describe them, I would not care whether the money was coming because it had been mandated or because it had been promised. It makes little difference. I certainly congratulate the Government on actually spending that money, which is far and away the most important thing.
	Let me deal with the deregulation Bill—legislation announced in the Queen’s Speech to reduce the body of existing legislation. I feel that an awful lot more can be
	done. The Bill has not been published, but I think that the Government have been too modest in their ambitions when it comes to deregulation. The Better Regulation Task Force is producing some really strong ideas.

John Woodcock: I am fascinated by what the hon. Gentleman is saying. Perhaps he was about to mention this, but what does he want to deregulate?

James Duddridge: At the moment, we have piecemeal deregulation, whereby we look at specific issues and then deregulate. I was elected as chair of the Regulatory Reform Committee, which as a body deals with pieces of legislative reform that the Government think can be fast-tracked for regulation or deregulation in order to avoid burdensome regulation. That is very much a piecemeal process—we looked, for example, at veterinary legislation—but it would be much better to have a big thematic review of issues surrounding care homes, for example. Rather than look at health and safety, the medical issues or equipment separately, it would be better to have a thematic review, cutting across Departments in the same way this debate cuts across the division between the health service and social services, local councils and different funding streams. I think it is our responsibility to do that here in the House of Commons.
	The deregulation Bill will be good and tidy up bits of the statute book, but I would like to see a lot more detail about how that is going to happen. A Joint Committee will be set up between the Lords and the Commons, and I would very much like to serve on it, but as much as possible, we should open out the number of Bills that we are looking at. Setting aside the issue of whether we should be in or out of Europe, the increase in European legislation demands that we face up to a two-for-one deregulatory challenge, just to stay standing. We need to go further.
	The economy is another key theme in the Queen’s Speech. Given our current economic position, if we had had a Conservative Government from the outset, I believe such a Government would have tested every single Bill by asking, “Will this Bill help the economy? If not, it is marginal, and we should push it to one side—certainly when it comes to parliamentary time and impact.” I think that the Budget is much more important. When we highlight the themes in the Queen’s Speech, we should not judge ourselves by the amount of paperwork we sign off. The Budget is, in many ways, more important. Corporation tax, the national insurance deal and so forth will get Britain booming. I have seen it in my local area, where, for example, Southend airport has boomed, generating over 500 jobs in the few years that it has been motoring in a serious way, as opposed to when it was a rather hobbyist airport. There is much still to be done, but we should not judge ourselves by the volume of legislation. In fact, through the deregulation Bill, we should be able to reduce that volume.

Grahame Morris: I thought that, rather than speaking about Europe or votes for prisoners, I might make a couple of points about health and social care.
	There are many provisions that I should have liked the Government to include in their legislative programme. For instance, I should have liked to see a commitment
	to extending freedom of information requests to private health care companies. I should also have liked to see a commitment to excluding health care from the scope of trade agreements as part of a broader exclusion of public services. I understand that the Prime Minister is involved in negotiations at this moment, and I hope that the trade agreement issue is on his agenda, because there is an increasing fear among Opposition Members that—in that context, and also as a result of the Health and Social Care Act 2012—our health care system is being prepared for privatisation, and the way is being cleared for the mass entry of United States health care multinationals to the UK market.
	I am pleased that the Care Bill is to be introduced in the current Session. It will go some way towards helping those who are most in need of social care, as well as their carers, providing as it does the first ever legislative framework for social care. It is a much-needed first step in the right direction, which has been a long time coming. However, it raises a great many issues. As usual with this Government, we need to look beneath the veneer and establish whether an opportunity is being taken or missed, and whether we are taking one step forward and several steps back. It would certainly be a retrograde step to raise expectations only for them to be dashed as people discover that the proposals are really quite limited. We need to be honest about what is on offer.
	Members often receive some shocking and surprising statistics in their mailbags, but some of the most surprising pieces of information that I have seen relate to social care. I must thank a range of organisations—including Scope, Age UK, the Alzheimer’s Society, the TUC, the British Medical Association, Barnardo’s and the European Federation of Public Service Unions—for supplying briefings to me and to other Members. It shames me, and I am sure it shames Members in all parts of the House, that in Britain in the 21st century four out of 10 disabled people who receive social care support say that it does not meet their needs. That was established recently by research on social care conducted by the disability charity Scope following the publication of a report by the Joint Committee on the draft Care and Support Bill, on which I served. It is feared that the current provisions, and some of those that are proposed, will not be sufficient.
	Other Members have welcomed the Bill. However, it is hugely worrying that local government finance has been hollowed out. That will have major consequences. It has been said that local government allocations for social care are protected, but they are certainly not protected when it comes to provision for transport and other supplementary services that are of value to members of the group involved. Many organisations have pointed out that setting eligibility criteria for care at “moderate” is essential if this framework is to be effective. As the hon. Member for Bradford East (Mr Ward) pointed out, according to the findings of a survey by Scope, by 2012 84% of councils had set their eligibility criteria at the “substantial” threshold. That represents an increase of nearly a third since 2005. As a result, only 14% of people with “moderate” needs are now receiving care, and the findings of recent surveys suggest that the position will only get worse.
	According to Marc Bush, head of research and public policy at Scope,
	“if we take moderate level needs, there are 36,000 people within the system of working age who, if the reforms go through as they are currently set, would fall out of the care system…if you do not meet need early, people's needs escalate and the costs escalate.”
	Mr Bush’s evidence is in paragraph 186 of the Joint Committee’s report. Indeed, the Local Government Association has estimated that by 2019-20, 45% of council budgets will be spent on social care. Unless we increase substantially the amount of resources available—

Madeleine Moon: There is pressure on people with illnesses and with disabilities if they do not get access to that social care, but should we not acknowledge the wider pressures on their families, who have to fill that gap all too often? That means taking time off from work and reducing the time spent on their leisure pursuits, thereby adding to family tensions.

Grahame Morris: That is an excellent point. The role of carers and families is absolutely critical; they are an army of unsung heroes.
	We cannot build a quality care service based on driving down the terms and conditions of the people who deliver it. I am very concerned about the increase in the number of zero-hour contracts, through which staff are paid the bare minimum. Such contracts are increasingly being used by private care companies seeking flexibility when meeting short-term staffing needs, and they often lead to job insecurity and a lack of appreciation of workers. We are seeing the fragmentation of social care, driven by the pressure to cut costs, which only places obstacles in the way of quality and of integrating services. Contracting out and privatisation also make it more difficult to have joined-up services, and there is a real risk that local authorities will find it impossible to comply with their new duties.
	We should be honest about what the Bill can achieve. It is a framework. It is paving legislation. It will not stop people having to sell their homes to pay for care. Under the existing deferred payment scheme, councils can loan money to people to cover their care costs, which has to be paid back by selling the family home after the elderly person has died. The Government propose something similar, but unlike the current system, interest is charged on the loan. The care Bill will not necessarily cap at £72,000 the costs elderly people actually pay for residential care. As has been said, hotel and other accommodation charges are not covered. Many elderly people in care homes will die long before they reach the cap that is being trumpeted as such a success. It certainly will not mean that pensioners get their care for free if they have income or assets worth up to £123,000. Elderly people will get free care only if they have income or assets under the lower means-tested threshold, which is not being increased and will be £17,000 in 2016.
	More widely, the care Bill does nothing to address the funding crisis in social care or to help those who face a daily struggle to get the support they need right now. Elderly and disabled people are facing huge increases in home care charges, which are a stealth tax on the most vulnerable people in society. Few older people are getting their care for free, and more older and disabled people are being forced to pay for more vital services that help them to get up in the morning and get washed, dressed and fed.
	We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people to stay healthy and live independently in their own homes for as long as possible. That would truly reinstate the idea of people being looked after from cradle to grave—a worthy extension of Aneurin Bevan’s legacy. Labour’s alternative is integrated, whole-person care, incorporating health, mental health and social care in a truly national health and social care service.

John Glen: I welcome the Queen’s Speech, particularly where it promotes the interests of people in our society who work hard, want to get on and recognise that in the long term their well-being is likely to be sustained when they rely more on themselves than on the state.
	I want to focus most of my remarks on the Care Bill and on the absence of the plain packaging legislation. Before I do so, I make the observation that the integrity of the Government and their ultimate success will be reliant not so much on what they say on Europe, but on what they deliver on welfare reform and the state of the economy. Thankfully, there was no significant new legislation on welfare reform in the Queen’s Speech, because it is now about the delivery of what we have already brought before Parliament. I am delighted that the Government are listening carefully and working deliberately and carefully through the process of pilots before bringing in fully the welfare reform.
	One aspect of that reform, referred to in the Queen’s Speech, is access to benefits for immigrants. It is right that the Government are considering limiting access to housing benefit and health care for people who have not earned the right to it. It is not enough to keep ignoring that uncomfortable truth because we are frightened of being too right wing, too nasty or too unpleasant. The routine experience of people up and down this country is that on the front line, at the point of delivery and at the point of receiving public services, they are too often displaced by people who, apparently, should not have the right to access those services. I am pleased that the Government will address that in legislation.
	On the health aspects that are the focus of today’s debate, it is right that the Government have finally introduced the Care Bill, as every constituency MP has been concerned about this issue for many years. In some of our earlier exchanges today, we have, as usual, debated who cut what when. I do know that before 2010—or before 2007—there were prolonged periods when this country had significant surpluses of moneys and, despite considerable evidence indicating that reform of the care system was required, nothing was done. I am therefore pleased that the coalition Government have found a way forward.
	Some specific details on how the arrangements will work—the interaction with the local authorities, and the timing and practicalities of the cap roll-out—need to be delivered. That requires a spirit of collaboration and constructive engagement, and an examination of the complexity of multiple agencies of government working together to deliver care in circumstances that cannot always be defined by legislation. Too often in these debates we use examples from our constituency case load, which are often emotive and provoke an emotional response, but our responsibility as Members
	of Parliament is surely to absorb and take on those challenging individual cases, and to work through the different processes of government to see that better outcomes accrue and occur. We must also reflect honestly on the systems that led to those failures, and distinguish between the systems that may have failed and cases where—sadly, unfortunately—human error and individual failures led to dissatisfied constituents.
	We must be honest about issues with the NHS, because we need behavioural change and a different appetite among the electorate for public health measures. We also need to take a constructive view about what is affordable with pensions. Therefore, I welcome the single-tier pension, which simplifies a lot of the complexity that has developed in our system.
	I am deeply disappointed that the Government have failed to include legislation on plain packaging of cigarettes explicitly in the Queen’s Speech. I completely agree with the speech made by the hon. Member for Barnsley Central (Dan Jarvis). When we have 10 million smokers, when two thirds of those who start smoking do so before the age of 18 and when 200,000 young people start to smoke every year, it is not enough to rely on arguments about the complexity of illegal trafficking.

Mark Lazarowicz: The hon. Gentleman is making an important and valid point and we have heard a number of his colleagues making similar points; I suggest that they table an amendment on the issue. If they do so, they might find that a lot of Labour Members support them, and who knows what might happen?

John Glen: I am grateful to the hon. Gentleman for that intervention, but I think we have had quite enough amendments this week.
	Nevertheless, the point remains that we cannot rely on a debate about the issues of the illegal production of illicit cigarettes or in the packaging industry; those issues need to be tackled head-on. The core point is this: why does the tobacco industry spend so much money on elaborate packaging? It does so because such packaging works and because it encourages young people to take up the habit of smoking.
	In this Chamber, the hon. Member for Shipley (Philip Davies) would usually sit next to me. Fortunately he is not here today, because if he were I am sure he would have intervened. He would have said it should be about freedom to choose. I am sorry, but I do not believe that 16-year-olds faced with massive peer pressure in certain communities genuinely have freedom to choose. It is not enough to say that the Government gain lots of tax revenues. For those individuals and their families, the health implications of smoking are dire. The situation is disappointing and I hope that a private Member’s Bill or another mechanism will be found to address the issue before the end of this Parliament.

James Duddridge: I am persuaded to a degree by my hon. Friend’s argument, and if plain packaging was the solution that would eliminate the problem, I would be inclined to vote for it. However, I cannot help but think that there will be something else around the corner, such as a ban on smoking in films or a ban on role models being seen to smoke, and ultimately an absolute ban on smoking. That might well be the right answer, but I am not quite sure where the debate is going.

John Glen: The reality is that smoking is almost unique in its proven health implications, the fact that it is so addictive and the fact that, particularly for young people, the implications for their future health are dire. We cannot just use the “freedom” arguments or ask “Where will the debate go?” to hide from that reality. We have a responsibility to do something about it.
	I want to use my remaining time to speak to focus on the issue of rhetoric versus reality and the gap between the two, because I recognise that the election results a couple of weeks ago threw up big issues for my party about how we handle that. That takes me back to what I said at the outset. Most people want a Government who are concerned about the economic well-being of this country, about generating growth, about delivering fairly provided quality public services that not only look after the most vulnerable properly but give incentives to those people who can create wealth and jobs to do so, and about allowing the economy to prosper.
	I think it would be wrong to get into a trade-off of rhetoric on the Europe issue, because all the proposed solutions are a long way off. The reality for this Government is that it will be a slow, hard and difficult process, but it is one that is well set out in this Queen’s Speech, with practical, sensible measures that are likely to win support over the course of the remainder of this Parliament.

Mark Lazarowicz: It is appropriate that I should follow the hon. Member for Salisbury (John Glen), as he made an important point about the economic aspects of the Queen’s Speech, and that serves to remind us that health is not just a matter of hospitals, doctors, nurses and medicine—important though all that is—but it is also affected by Government policies in other areas. I disagree with the hon. Gentleman in this respect, as I am very concerned that many of this Government’s policies are, directly or indirectly, having a damaging effect on the health of many millions of people in this country.
	The first of those effects is illustrated by the growth in real poverty, which has led to the mushrooming number of food banks throughout the UK. I now have two food banks operating in my constituency, along with other sources of free food for those in need, and that situation is replicated in every constituency across the land. The food provided through the food banks is healthy food that is beneficial to the diets of those who receive it. In most cases food is provided only for a limited period, however, which suggests that at other times those who depend on food banks do not get decent meals and a decent diet, and often go hungry. Evidence from the Trussell Trust suggests that about one third of the people who are dependent on food banks are children, and we all know that those who have a bad diet at the beginning of their life can face serious lifelong consequences.
	I acknowledge that the reasons why people go to food banks are complex. There is a world economic crisis and increases in food prices at a worldwide level, so I do not pin all the blame on this Government’s policies. No doubt in the current global circumstances we would have seen an increase in food banks under any Government. I would, however, have liked to have heard some mention in the Queen’s Speech about policies that would serve to tackle child poverty and the scandal of so many in our society being dependent on food banks.
	We might have reversed policies such as the 1% cut in many benefits that passed through Parliament not long ago. Another broader area that has a direct impact on health is poor-quality housing and lack of housing provision. The situation has been exacerbated by the bedroom tax. There cannot be a single MP on either side of the House who has not been contacted by constituents who are suffering directly as a result of the introduction of the bedroom tax. I shall not comment on the tragic case recently reported in the media and which was mentioned earlier, but I know of plenty of cases in my constituency where people’s lives have been turned upside down by the bedroom tax. It often has a serious effect on their mental health and sometimes takes away their ability to work, which in turn affects their ability to feed themselves and their family and to meet their energy bills. So, too, does the fact that the bedroom tax leads to people losing benefits, but there was not a word in the Queen’s Speech to amend a policy that has increasingly been shown to be indefensible.
	The housing problem is not just about homes being under-occupied. Many of us know from our own constituencies about the problems of poor-quality housing, overcrowded housing and lack of affordable housing. The Queen’s Speech did not give sufficient priority to addressing that. Yes, there were policies designed to support the housing market, some of which will have benefits as regards affordable housing, and I welcome that. However, the Government still seem desperately keen to promote a housing boom at the higher end of the market, because houses worth up to £600,000 will be eligible for their programme. Again, that is an example of the wrong priorities when the real priority should have been to tackle poor-quality housing, and not to force people into the terrible situation in which many find themselves because of the bedroom tax.
	Another area where wider policies have a direct impact on health is employment. We all know that health and being in a job go together. In many cases, being unable to work or being in insecure employment is likely to be extremely damaging to health. I was taken by the comments of my hon. Friend the Member for Easington (Grahame M. Morris) about workers on zero-hours contracts in the health service. That is not only bad for the health service but for the workers whose health may be directly affected by the insecurity of being in such a situation.
	No matter what the official employment figures say, and they are bad enough, the reality of unemployment, low employment and under-employment is underestimated. In all our constituencies, people are working part-time when they do not want to and being forced to take large wage cuts. We have the spectre of people working on zero-hours contracts, returning to a day-labourer system where people do not know from day to day whether they will be in employment. If anyone thinks that that does not have direct effects on people’s health and well-being, they are deluding themselves. If we do not tackle these issues, there will be increasing health problems for many people in our society. That is why Labour’s job-creation programmes, which we will discuss in later debates on the Queen’s Speech, are so important. We also need international action, with a change in direction to get away from the austerity programmes that are causing so many problems and so much unhappiness not only in our country but throughout the rest of Europe.

Toby Perkins: The link between health and unemployment was addressed very well, under the previous model of the NHS, by Derbyshire primary care trust, which supported and funded programmes to get the long-term unemployed into work. This does not seem to be happening as much in the restructured NHS. Will my hon. Friend expand on the importance of getting the long-term unemployed into work and the impact that joblessness has on their health?

Mark Lazarowicz: My hon. Friend makes an important point. Measures to address long-term unemployment and child poverty, to tackle housing inequality and poor housing provision, and to provide more security in jobs and housing and in other ways are some of the biggest things that could have been done to promote health throughout our country.
	I wish that Conservative Members who have spoken in the debate on the Queen’s Speech and the debates leading up to it had shown as much concern and passion about these issues as they have with the in-fighting on European issues that has taken up so much of the internal debate within their party. I accept that in the past few hours we have heard mainly constructive and thoughtful speeches on health issues by Conservative Members, but I suspect that that is simply because the ones who are doing the plotting and the in-fighting are doing it elsewhere. It is a pity that more Conservative Members have not paid attention to the issues that the people in our country want addressed—health, employment and housing. In those areas we need a significant change in direction from the Government which the Queen’s Speech did not give us.

Sarah Champion: I would like focus on two groups of people who are not adequately covered in the Care Bill: young carers and the disabled.
	I recently had the pleasure of spending time with a remarkable group of Rotherham young carers who are supported by Barnardo’s. Because of funding limitations, Barnardo’s is able only to work with young people between the ages of eight and 18, and only 100 in a year. Sadly and shockingly, Barnardo’s estimates that 3,000 young people are carers in Rotherham alone. It has on its waiting list children as young as six who are counting down the days until their eighth birthday when they can get some support.
	The young carers asked me to make colleagues aware of their plight. Hannah told me that the main thing she wanted was recognition for the work she did. She understands her mum, who suffers from severe depression, better than anyone. Hannah wants her experience to be fed into her mum’s assessments. As she said,
	“they trust me to look after her but they don’t trust my opinions.”
	When Hannah calls the medics to say that her mum is deteriorating, she should be taken seriously. Instead, young carers have to contact their Barnardo’s worker to lobby on their behalf, because they are not recognised by the authorities.
	I welcomed many of the measures in the draft Care and Support Bill, but they are limited to adults caring for adults. The Care Bill represents a missed opportunity to improve the rights of all carers, including adults caring for children and young carers. The young carers I met know that, because of them, their parents do not
	have to stay in hospital, a mental institution or a care home. They know how much their help saves the Government. On their behalf, I urge the Minister to make sure that the Care Bill gives young carers a little support in exchange.
	Consolidating provisions relating to adult carers in previous Bills will create neat, codified legislation, with
	“clear legal entitlements to care and support”
	for adults, while young people will be left with piecemeal, leftover legislation that practitioners will struggle to navigate. This is highly problematic. As I have said, workers often need to act as advocates for young carers and protect their rights. This area has long faced the challenge of a confusing legal framework, and the Bill has the potential to make matters worse. It appears to provide a clear picture of carers’ rights, while in effect excluding some of the most vulnerable carers.
	I recognise that the bulk of the changes needed to protect young carers need to be made in the Children and Families Bill, but changes could also be made in the Care Bill. In order to prevent inappropriate caring, it is important that measures are put in place to ensure that adults’ needs are met and that young people with potential caring roles are identified as part of an adult’s assessment. Not only would that recognise the important role that young carers play, but it would allow their needs to be acknowledged formally, forcing existing services to be more accommodating. For example, all of the young carers I met faced challenges at school, with inflexibility on late homework, missing school and the need to call home during the day. If young carers are formally recognised as part of the assessment process, that could be fed through to the school and teachers could be notified of the young person’s needs, allowing them to be better supported.
	On the Bill’s implications for those with disabilities, my office has seen a marked increase in the number of cases of disabled people struggling to make ends meet. The introduction of the employment and support allowance has been confused and poorly administered. I have dealt with numerous cases of vulnerable people being placed in unnecessarily stressful situations and left financially worse off by this Government’s reforms. Such cases already make up 10% of my overall case load. The abolition of incapacity benefit will soon be followed by the abolition of the disability living allowance and the introduction of personal independence payments, meaning that disabled people are being squeezed at an unsustainable level.

John Woodcock: My hon. Friend is making an important speech. Does she share the concern of my local disability association that the problems with the ESA benefit and how it has been reassessed have led to grave worries about the introduction of personal independence payments?

Sarah Champion: I thank my hon. Friend for yet another example of the extreme stress that people are being put under and the mismanagement of this entire process. The pressure of the burden being placed on them is intolerable.
	I am extremely concerned that the Government’s Care Bill will put further pressure on that vulnerable group. The key issue for social care reform is eligibility. A third of social care users are working-age disabled people. The Bill will not improve the social care system
	for them, and 105,000 disabled will be shut out from receiving the social care that enables them to live their lives.
	My hon. Friend the Member for Easington (Grahame M. Morris) mentioned statistics from Scope that make depressing reading. Four in 10 disabled people who receive social care support say that it does not meet their basic needs, including eating, washing, dressing and just getting out of the house. A third of working-age disabled people say that cuts to their social care have prevented them from working or volunteering.
	The Bill appears to focus on the elderly and does not address the care crisis facing disabled people. For those working-age disabled people who do not meet the eligibility threshold, the £72,000 cap on care costs will not apply. They will continue to need to meet the cost of their social care. If an individual’s care needs increase later in their working life to the point that they become eligible for social care, the cap will not take into account the contributions they have already made to meet their care needs.
	I agree that the introduction of a national eligibility threshold is a step in the right direction. Alongside a new assessment system, I hope that it will end the postcode lottery in care provision. However, it is vital that the threshold is set at a level that ensures that working-age disabled people receive support to meet their basic needs.
	The Government spend £14.5 billion a year, or 2% of public expenditure, on adult social care, which includes older people’s services. However, it was estimated by the Dilnot commission that social care services are under-resourced by £2 billion. Those services are being further squeezed by the pressure of an ageing population and a 33% reduction in local council budgets. Local authorities are therefore dramatically under-resourced for the demands that are placed on them. As a consequence, they have been raising the threshold at which disabled people become eligible for support. Recent surveys suggest that almost half of local authorities plan to reduce spending on care services for adults, which will hit those with learning difficulties and those with disabilities.
	Unless there is sustainable funding for adult social care, the situation is likely to get worse. The upcoming spending review must be used to secure more long-term funding for social care services to underpin the Care Bill. The Government must not lose sight of disabled people and young people as the Bill progresses.

Jim Shannon: Will you confirm, Mr Deputy Speaker, that I may speak until 9.40?

Lindsay Hoyle: The hon. Gentleman has eight minutes, and if two interventions come along that will give him 10 minutes.

Jim Shannon: I am sure that my colleagues will intervene.
	I thoroughly enjoyed the opening of Parliament. It always fills me with a sense of optimism to look forward to another Session and what we can do. As the DUP Health spokesman, that optimism was dulled when I noted, with some dismay, that the Government had not
	included standardised cigarette packs in the Queen’s Speech. It would have been great to see essential measures on that.
	I am reminded of the dance, the hokey-cokey: they’re in for packaging, they’re out for packaging, they’re in for packaging, they’re out for packaging, and they swing it all about. I cannot do the hokey-cokey, but I know who can. The Government can do the hokey-cokey and nobody can do it better. Bruce Forsyth often says, “Didn’t they do well?” If he ever retires, there are two hon. Members who will be vying for his position.
	I am encouraged that some hon. Members have had the courage of their convictions. The hon. Member for Salisbury (John Glen) has taken a clear stance on plain packaging, as have other Members. I appreciate that.
	I have received many e-mails from constituents on this issue. One stated:
	“Since tobacco advertising became illegal in the UK, the tobacco companies have been investing a fortune on packaging design to attract new consumers. Most of these new consumers are children with 80% of smokers starting by the age of 19.”
	Other Members have made it clear that we must stop smoking being an attraction for young people. About 200,000 children as young as 11 years old are smoking already and the addiction kills one in two long-term users. A recent YouGov poll showed that 63% of the public back plain packaging and that only 16% are against it.
	Last week, I asked the Prime Minister whether he would introduce plain packaging. He said:
	“On the issue of plain packaging for cigarettes, the consultation is still under way”.—[Official Report, 8 May 2013; Vol. 563, c. 24.]
	That is not exactly accurate because the standardised packaging consultation started on 16 April last year and ended nine months ago on 10 August 2012. I am keen to hear from the Government just what is happening.

Chris Ruane: I am just doing Mr Deputy Speaker’s bidding by intervening to give the hon. Gentleman an extra minute. When plain packaging was introduced in Australia, the tobacco industry fought the longest, dirtiest battle it had ever fought against any Government proposal to curb smoking. Why does the hon. Gentleman think that was? It threatened that triads would come over from China and take over Australia, but that never occurred. Why did it threaten so much and fight so hard? Is he pleased that it lost?

Jim Shannon: I thank the hon. Gentleman for his intervention. I perceive and am of the opinion that companies saw such measures as a loss to their profit margin, and we would like to see what happened in Australia happen here.
	The former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley),was quoted in the media saying that the Government did not work with tobacco companies as they wanted them to have “no business” in the UK. Has that changed? The current Health Secretary stated that one of his key priorities is to reduce premature mortality. His call to action on premature mortality commits to a decision on whether to proceed with standard packaging. He also stated:
	“Just because something is not in the Queen’s Speech doesn’t mean that the Government cannot bring it forward in law.”
	Even at this late stage, may we hear a commitment to bringing forth such a measure in law? If we do, that will be good news and we will welcome it.
	Some 10 million adults smoke in the UK and more than 200,000 children start smoking at a very early age. More than 100,000 people die from cancer-related smoking diseases across the UK, which is more than from the next six causes of preventable death put together. The immensity of the number of deaths from smoking cannot be underestimated. Many Members have spoken about that, and I believe the fact we are all saying the same thing is something we should underline.
	We cannot remove people’s choice to smoke—that is a decision to be made by any adult—but we can, and must, ensure that everyone knows they are doing harm to themselves and those around them. Evidence that standardised packaging helps smokers quit and prevents young people from taking up the habit and facing a lifetime of addiction is clear, and we should encourage more people to stop smoking and not to become addicted.

Frank Dobson: Does the hon. Gentleman agree that the argument sometimes put by defenders of the tobacco industry—usually paid defenders—is that people are exercising free choice? In fact, they are not exercising free choice because they are addicts who took up the addiction when tobacco companies persuaded them to smoke when they were teenagers.

Jim Shannon: I thank the right hon. Gentleman for that intervention and for clearly underlining the stand we are all taking on this issue. We hope that Ministers will respond positively. I believe that plain packaging is a major step in this informational and educational journey to end smoking, and I ask the Minister to commit today to begin that journey that has been planned for so long.
	Another disappointment in last week’s speech was the lack of reference to the minimum pricing of alcohol, although there has been some indication that there may be a change of heart, which we hope will be the case. Last week I was sent a copy of a study containing numerous sources, and there are certainly some shocking statistics. Its findings, among other pertinent points, demonstrate that alcohol is 45% more affordable today than it was in 1980. Men and women can currently exceed the recommended low-risk daily drinking guidelines for £1. That is hard to believe in this day and age, but it is the truth. Data from Canadian provinces suggest that a 10% increase in the average minimum price would result in about an 8% reduction in consumption, a 9% reduction in hospital admissions, and—this is the big one, Mr Deputy Speaker—a 32% reduction in deaths caused wholly by alcohol, which is even higher than the figure suggested in the Government’s impact assessment.
	Alcohol Health Alliance UK stated:
	“The case for introducing minimum unit pricing is clearer than ever, yet despite committing to the principle of minimum unit pricing, it appears that the Government are going to drop the measure from their alcohol strategy.”
	Perhaps Ministers will comment on that, but I sincerely hope it is not the case. Minimum pricing of alcohol is not to ensure that those on low incomes cannot have a drink, but to ensure that people of all incomes are aware how much they are drinking and conscious of the
	health implications of excessive or binge drinking. When it comes to minimum pricing for alcohol, we can all take note and take advantage of it.
	Every year there are 1.5 million victims of alcohol-fuelled violence in the United Kingdom, and it is clear that community safety is threatened by the misuse of alcohol. Police superintendents have advised that alcohol is present in half of all crimes committed, and a 1990 study for the Home Office found that growth in beer consumption was the single most important factor in explaining the growth in crimes of violence against the person. The figures are clear. Statistics show that 37% of offenders had a current problem with alcohol; 37% had a problem with binge drinking; 47% have misused alcohol in the past; and 32% had violent behaviour related to their alcohol use. When we mix young people, who have not had time to develop their moral standards and ideals, with alcohol, we have a generation who are fuelled by the desire to live in the moment, with no thought of the consequences. Alcohol changes personalities, and young people are only learning who they are. Adding alcohol to the mix means that they will never have a good understanding of who they are. A minimum price for alcohol will lessen the number of young people who drink copious amounts of it. Hopefully, it will also mean a lessening of crimes that are aggravated or exacerbated by alcohol.
	My third point is on diabetes, which is a ticking bomb in our society. We had a debate on it in Westminster Hall, when the right hon. Member for Leicester East (Keith Vaz) made the point about diabetes and obesity among children. The figures are overwhelming. The United Kingdom of Great Britain and Northern Ireland diabetes strategy ended in April, but perhaps the Minister can tonight commit to its continuation. I believe the strategy was working. Had it not had an effect, the figures would be much worse. Even given the strategy, the number of people living with types 1 and 2 diabetes has increased by 33% in Northern Ireland, 25% in England, 20% in Wales, and 18% in Scotland. The numbers are rising. A commitment to the continuation of the strategy would be helpful. The statistics are scary—3.7 million people in the UK are diagnosed with type 2 diabetes. However, we are talking not only about statistics, but about people’s lives. We need to prevent and control as well as we can.
	I am aware that the health portfolio is not an easy one. Everybody needs something urgently. I understand the restrictions that apply, but does the Minister understand that the three issues that I and others have raised affect every corner of the United Kingdom of Great Britain and Northern Ireland? I believe we could have reform on those issues if the Government put their hand to the plough and disregard all but the health and safety of our population.

Liz Kendall: It is a great pleasure to speak at the close of the debate after so many passionate and thoughtful speeches from hon. Members on both sides of the House.
	My right hon. Friend the Member for Stirling (Mrs McGuire) and the hon. Member for Truro and Falmouth (Sarah Newton), who is not in her seat, rightly stressed that, although many debates on the future of health and care services focus on the needs of older
	people, social care is critical to adults of working age. My hon. Friends the Members for Bridgend (Mrs Moon), for Worsley and Eccles South (Barbara Keeley), and for Rotherham (Sarah Champion), spoke of the vital role of unpaid family carers, who are the bedrock on which the care system rests. They spoke particularly of the needs of young carers, who often feel that their childhood is being taken away from them by their caring responsibilities.
	My hon. Friends the Members for Birmingham, Selly Oak (Steve McCabe), for Easington (Grahame M. Morris) and for City of Durham (Roberta Blackman-Woods) spoke of the growing crisis in social care funding, the increase in care charges that family members must pay, and the pressures on services and support. The hon. Member for Stafford (Jeremy Lefroy) gave, as ever, a thoughtful speech on how we might pay for NHS and social care in future. There will be different views on his proposals, but he made, as ever, a thoughtful contribution.
	My hon. Friends the Members for Stretford and Urmston (Kate Green) and for Barrow and Furness (John Woodcock) rightly said that we have a duty to provide decent compensation and care for mesothelioma sufferers. My right hon. Friend the Member for Rother Valley (Mr Barron), my hon. Friends the Members for Vale of Clwyd (Chris Ruane), for Sheffield Central (Paul Blomfield), for Gateshead (Ian Mearns) and for Barnsley Central (Dan Jarvis), and the hon. Members for Salisbury (John Glen), for Mid Derbyshire (Pauline Latham) and for Strangford (Jim Shannon), spoke with passion about the Government’s failure to introduce standardised packaging for cigarettes to reduce premature deaths from smoking in this country. I hope the Government think again on that. Finally, my right hon. Friend the Member for Cynon Valley (Ann Clwyd) once again gave a direct voice to people who have suffered from unacceptably poor standards of care in the NHS. My right hon. Friend and all of us here are absolutely determined to stamp those out.
	I want to focus on the measures in the Queen’s Speech on social care. The current legislation on adult social care is complex and confusing, and it needs reform. That is why the previous Labour Government set up the Law Commission review, which has led to many of the measures in the Care Bill. We support the new rights that the Bill contains; they build on the rights that Labour introduced in government, such as the right for family carers to request flexible working.
	During the Bill’s passage, we will work to ensure that older and disabled people and their family carers get the best possible deal. We will seek to make amendments where there are serious omissions, such as the needs of young carers, or where improvements should be made, such as introducing free social care at the end of life. Organisations such as Sue Ryder and Macmillan Cancer Support have shown that such care can give people more choice about the place of their deaths and save taxpayers money by reducing the need for more expensive hospital care.
	Those new rights, however welcome, risk being meaningless if people cannot get the services and support they need on the ground. That is the reality that hundreds of thousands of people now face. The 70 organisations that make up the Care and Support Alliance are clear
	that the Bill will not solve the crisis now engulfing social care. They warn that there is now a real danger that most people—not some, but most—will not get the help they need just to get up, dressed and out of the house as councils struggle to cope with swingeing budget cuts and growing demand.
	Ever tighter eligibility criteria for council support mean that fewer older and disabled people get the help that they desperately need. Let us be clear. People talk about providing care and support only for people with substantial needs but not for those with moderate needs, but those latter needs are serious. I have seen in my constituency that “substantial needs” involve only people with terminal illnesses or who are incontinent or blind. There are many other very high levels of need. We are missing out support for those who desperately need it.
	Even when people do qualify, they routinely face 15-minute home visits—barely enough time to get an elderly, frail, vulnerable person with dementia up, washed, dressed and fed. People wait a long time to get basic help such as grab rails and stairlifts so they are without the support for basic preventive care that helps people to live independently at home, which is what they and their families desperately want. Family carers are left struggling without the breaks that they need just to keep going or even a bit of emotional support and advice on the phone, as local voluntary organisations cut back and close.
	The tragedy is not just that older and disabled people and their family carers suffer; it is that taxpayers end up paying more for the price of failure. Elderly people have to go into more expensive hospitals or residential care when they do not need to, because they cannot get the support they need in the community or at home. One in three family carers have to give up work or reduce their hours because they cannot get the help they need to care for their loved ones. Their own health suffers, which puts more pressure on the NHS, and their income suffers. The Treasury loses more than £5 billion a year in lost tax revenues and benefit bills because those family carers have to give up work.
	The Government remain in complete denial about the scale of the care crisis we now face. They have been repeatedly warned by local councils about what the cuts in budgets and pressures on services mean. Councils are warning that in 15 years’ time they will not be able to provide the services that members of the community want and like—the libraries, leisure services and swimming —because of the pressures on local council adult social care budgets. The Government refuse to listen.
	The Government are not being straight with people about their future plans either. The Prime Minister, Deputy Prime Minister and Health Secretary have repeatedly said that no one will have to sell their home to pay for their care. That simply is not the case. In future, all local authorities will have a duty to offer deferred payment schemes, lending people money to pay for their residential care. However, the loans will have to be paid back, after the elderly person has died, by selling the family home. The Government’s new scheme will charge interest on the loans, unlike under the current system, so people will lose even more of their family home than they do now. However, they have not told the public that they will be paying more, with that interest, under their new scheme. Will the Minister now come clean and tell families how much interest they will be charged? Will the Minister tell us
	how much interest families will be charged? Will he give a straight answer? He is not going to now. I hope he will when he responds to the debate.
	Ministers also repeatedly claim that the Bill will cap the amount people are charged for their care at £72,000. The Health Secretary was at it again when he was at the Dispatch Box today, claiming that the Bill sets “a finite maximum cost” that individuals will have to pay. Again, that simply is not the case. The so-called cap on care costs is based on the standard rate local councils would pay for their residential care in their area—approximately £480 a week nationally—and not what people actually pay for their care. The 125,000 people who fund their own care fully, and many more who pay top-ups, will face far higher bills, particularly in the south and east of England. Government Members should take heed of that point, because if they tell their constituents that there will be a finite cap on their care costs, they will be sorely disappointed. The extra costs, above and beyond the standard rate that councils pay, will not count towards the cap. That means that older people will think they have reached it when they have not. In reality, it will take four years to hit the cap, yet the average length of stay in a care home is just over two years, and a quarter of people in care homes die after just a year. In other words, most people will be dead years before they reach the cap. Even if they are still alive, the state will pay only the standard council rate, leaving self-funders no choice other than to either leave the care home and move somewhere cheaper, or to pick up the extra costs.
	The Government have failed to explain that people will not get their care for free if they have income or assets worth up to £123,000, the new increased upper means-tested limit. They will get care for free only under the lower means-tested limit, which is not being increased, and will be £17,500 in 2017. In between, there is a sliding scale of support. However, the way the means test works will mean that pensioners on average incomes—those who have worked hard and saved for a modest second pension of, say, £80 a week—will not get any council support, even with the increased upper means-tested limit, because councils calculate it by determining a notional income based on the capital in people’s homes. That, combined with the average pensioner income, takes them above the level at which they would receive council-funded support.
	Government Members look surprised. That is unsurprising, as their Ministers have not spelled out the reality of the Government’s plans. Ministers should be straight about what their plans really mean, so that older and disabled people and their families can plan for the future properly. Instead, they tour the TV studios and make statements to this House giving false reassurances that are simply not borne out by the facts. We all know that people are fed up with politicians who say one thing and do another: claiming that people’s care costs will be capped when they will not, and claiming that raising the means test will help pensioners on average incomes with modest second pensions when it will not. I warn Government Members that that will not help to restore faith in politics or politicians, or help us to plan properly for the future.
	Things could and should have been so different. Rather than forcing through their damaging and distracting backroom NHS reorganisation, the Government should
	have spent the last three years laser-focused on the service reforms people desperately need, shifting care out of hospitals and into the community and more towards prevention. Instead of diluting Dilnot’s proposals and then misrepresenting them to the public, they should have engaged in meaningful cross-party talks to agree a system that helps those on low and modest incomes, not just those predominantly at the top. And instead of driving greater fragmentation of NHS care services, jeopardising some of the best examples of integrated care, such as in Torbay, they should have adopted Labour’s plans for whole-person care, a single service with a single budget, funded through a year of care, that would shift the emphasis out of hospitals and into the community and result in better care for people and better value for money for taxpayers too.
	Meeting the challenges of our ageing population is one of the biggest issues facing our country and society. We need a far bigger, bolder, straighter, clearer response, which this worn-out, divisive and divided coalition will never provide.

Norman Lamb: I thank hon. Members for their contributions to the debate.
	Despite all the knocks that Opposition Members like to give it, the NHS is performing remarkably well, with 3.3 million more out-patient appointments, more than 500,000 operations, 1.5 million more diagnostic tests, MRSA infections halved and record low numbers of people waiting more than a year for their operations—just 665 people, down from 18,000 in 2010. These are real achievements for the NHS, and we should applaud and pay tribute to a really remarkable work force that has achieved these things despite tough economic times. The last Government rightly set in train £20 billion of efficiency savings, and those savings are being achieved despite the tough challenges.
	Despite the doom and gloom heard during the debate, some brilliant things are happening in social care, including in some Labour authorities. In Leeds and Barnsley, for example, great things are happening, with people looking at new ways of doing things and redesigning services, recognising that times are tough and that, even under a Labour Government, they would face the same challenges. I recognise, however, that the system is facing real pressures, so it is disappointing that the Opposition, including the shadow Secretary of State and shadow Minister, the hon. Member for Leicester West (Liz Kendall), sought to polarise the debate by making exaggerated claims about the state of the NHS, when we all know the truth, which is that pressures are growing and have been for a long time. We have people living with long-term conditions, often for many years, and with a mix of mental and physical health problems. Those are the difficult cases sometimes clogging up our A and E departments, so let us have a mature debate about how we deal with the challenges.
	We have a completely fragmented system and we are not spending money effectively to achieve the best possible care. Mental health is institutionally entirely separate from physical health, health care is separate from social care, and primary care is separated from hospital care. The whole urgent care system is under significant pressure. [Interruption.] I tell the shadow Secretary of State that
	on some of these issues we in fact agree more than he would sometimes like us to believe. The system is dysfunctional and we have to change it. We have had 4 million more people visiting A and E since the disastrous renegotiation of the GP contract by the last Labour Government. The hon. Member for South West Devon (Mr Streeter) talked about the significant pressures on A and E. Let me reassure him that Monitor and NHS England have issued a call for evidence on how the tariff system is working, with a view potentially to reforming it.

Liz Kendall: Does the Minister agree that in 2009, five years after the GP contract was agreed, 98% of patients were seen in A and E within four hours?

Norman Lamb: What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.
	Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.
	It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system
	works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

Barbara Keeley: The Minister is back on his point about the Bill creating a single statute, but it will not do that for young carers, who will be left with the protection only of the private Member’s Bills I mentioned earlier. It is not good enough for young carers to face a higher threshold than other carers before their needs are assessed. That has to be looked at. The children’s Minister has let the House down on this issue; I hope that this Minister will not do that.

Norman Lamb: I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.
	The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.
	The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.
	The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

Frank Dobson: Does the Minister accept that a generalised rating for a hospital is not going to be valuable because, within one hospital, some departments
	might be doing a brilliant job while others are not? It would be stupid if an overall rating persuaded people not to go to a particular hospital for treatment if the specialty they required was being practised brilliantly.

Norman Lamb: I disagree. We brought in Jennifer Dixon of the Nuffield Trust to advise on this matter. There will be ratings for specific services within hospitals to identify areas of great care, but the single rating will give the hospital the incentive to bring up to a proper standard those areas that are falling short, and that will be a good thing.

Alison Seabeck: Will the Minister give way?

Norman Lamb: I want to make some progress; I am conscious of the time.
	The Bill will introduce a single failure regime, so that, for the first time, a trust can be put into administration because of quality failure as well as financial failure. Until now, it has been only the finances that can put a trust into administration. This Government recognise that quality failure is just as important, if not more so, and that such failure must carry consequences.
	The stories recounted by the right hon. Member for Cynon Valley (Ann Clwyd) and the hon. Member for Bridgend (Mrs Moon) reinforce our determination to make improvements and to ensure that people get the best possible care. I again pay tribute to the impressive work carried out by the right hon. Lady, and I thank her for her work on complaints procedures. The hon. Member for Mid Bedfordshire (Nadine Dorries) also talked about the importance of compassion in good nursing care.
	The Bill will make it a criminal offence for providers to provide false and misleading information. My hon. Friend the Member for Stafford (Jeremy Lefroy), who has done great work representing his constituents in the most honourable and responsible way, drew our attention to the importance of mortality statistics being accurate so that we can rely on them. Alongside this Bill, we will introduce the statutory duty of candour—something of which I am personally proud. It does not require primary legislation, but the Government will introduce it.
	The funding of care is to be reformed so that there will be a cap on the care costs that people will pay in their lifetime. This is long overdue. Reform has been in
	the long grass for too long. Several hon. Members, including the hon. Members for Worcester (Mr Walker), for City of Chester (Stephen Mosley) and for Lancaster and Fleetwood (Eric Ollerenshaw), made the point that people will no longer have to sell their homes during their lifetime to pay for care. So often people have had to sell their homes in distress at the moment they go into a care home. When they cannot organise their affairs properly, they have to sell up to pay for care. No longer will that be the case. They can delay all those issues because of the right to deferred payments.
	It is this coalition Government who have bitten the bullet on a very important reform. I am very proud of the fact that we are doing this, introducing a long overdue reform. Andrew Dilnot himself has strongly supported the Government’s action. That is happening together with a very significant extension of support—I take on board what the hon. Member for Leicester West said—to help people of modest means with their care costs. Each one of those measures would be significant by themselves. Together, they provide real optimism that we can shake off the shackles of the past and look towards the future, not with fear, but with optimism. The Opposition are wrong to dismiss the importance of this Bill. They should recognise just how much it could improve the lives of some of the most vulnerable people in society.

Liz Kendall: rose—

Norman Lamb: I am going to conclude.
	We are two thirds of the way through this Parliament and we have already addressed big challenges that were ignored during Labour’s three terms in office. We have been and will always be 100% committed to an NHS that is not satisfied with mediocrity, but is always searching to be better, more focused, more helpful than ever before. Society is changing, drug costs are increasing and expectations are higher. The NHS and the social care system must change to meet those challenges and we are helping to make that happen, safeguarding the NHS now and in the future.
	Ordered, That the debate be now adjourned.— (Mr Swayne.)
	Debate to be resumed tomorrow.

CLEVELAND FIRE AUTHORITY

Motion made, and Question proposed, That this House do now adjourn.—(Mr Swayne.)

Tom Blenkinsop: First, I thank you, Mr Speaker, for giving me the opportunity to have this important Adjournment debate.
	I am sure that hon. and right hon. Members—at least those on the Opposition Benches—are acutely aware of the financial squeeze being applied to their fire and rescue authorities by central Government. Indeed, two years ago, my hon. Friend the Member for Hartlepool (Mr Wright) raised the point that Cleveland’s government settlement was the second worst in the country. However, I fear that many Members and the public might not be aware of this Government’s support, both financial and political, for proposals to take front-line fire and rescue services out of the public sector.
	The Minister may say that this is not the case and that these services would remain under local authority control. However, the community interest company in the case of Cleveland fire authority, is already registered at Companies House as a separate entity, and managers are stating that an expansion of the existing CIC is the vehicle they intend to use for the formation of a “public service mutual”.
	Recently, fellow Cleveland MPs and I met the Cleveland fire authority. Let me make it clear now that the categorical statement from the chair and other members was that they would do nothing that would lead to the privatisation of the service. However, the chief fire officer said that any contract would be subject to competition after the initial contract awarded to any mutual expired. He said at that meeting that the initial contract could be for anything from three to nine years. My hon. Friend the Member for Stockton North (Alex Cunningham) and I have been greatly concerned about what the chief fire officer—along with, if I may add, firm Government encouragement—had proposed.

Alex Cunningham: I congratulate my hon. Friend on securing this important debate. I am sure he agrees that the Cleveland fire chief responsible for the area that probably has the highest fire risk in Europe is ploughing a lone furrow with his proposals, given that other fire chiefs throughout the country are dismissing the mutual model, and firefighters themselves are convinced that competition law would soon open the way for private companies to take them over and put profits—
	Motion lapsed (Standing Order No. 9(3).
	Motion made, and Question proposed, That this House do now adjourn. (Mr Swayne.)

Alex Cunningham: That took me a little by surprise, Mr. Speaker.
	I am expecting my hon. Friend to agree with me that the Cleveland fire chief responsible for the area that probably has the highest fire risk in Europe is ploughing a lone furrow with his proposals, given that other fire
	chiefs throughout the country are dismissing the mutual model, and firefighters themselves are convinced that competition law would soon open the way for private companies to take them over and put profits before people—for the second time of asking.

Mr Speaker: We probably got it the first time, and certainly the second.

Tom Blenkinsop: I think you will agree, Mr. Speaker, that it was such an important point that it had to be made a second time. I shall develop my response to it during my speech, if my hon. Friend will allow me to do so.
	In Cleveland, the chief fire officer is exploring the possibility of spinning out the fire brigade. The whole range of fire and rescue services activity, including emergency response, is being examined for the purposes of being “spun out”—to coin a Government phrase. The proposal is being supported by Ministers in the Department for Communities and Local Government and by the Cabinet Office, which is spending over £100,000 on the legal advice that will be necessary for the pursuing of such a restructuring.

James Wharton: Will the hon. Gentleman give way?

Tom Blenkinsop: I will, although Members normally inform the Member who has secured the debate that they wish to intervene.

James Wharton: I thank the hon. Gentleman for his generosity. He was at the same meeting with the fire authority and the chief fire officer that I attended with the hon. Member for Stockton North (Alex Cunningham). We discussed these matters then, and I think that the main concern among all the MPs who were present was to ensure that the employment rights of the people who work for the fire service were protected.
	The hon. Gentleman has mentioned the organisations that he thinks are backing this proposal. Will he acknowledge that it is the Labour-run fire authority that is pushing it, and the Labour chairman of the authority who thinks that it is such a good idea?

Tom Blenkinsop: We understand that, under the recent regulations introduced under the Government’s own Health and Social Care Act 2012, the TUPE regulations are worth about 90 days in practice. As for the hon. Gentleman’s claim that the Labour authority is pushing the proposal, the Labour chair actually said “If we were properly funded, we would not even consider going down this route.” As I shall make clear, this is a devolved blame game initiated by Ministers to thrust a mutilation of the concept of mutualisation on the people in Cleveland.

Iain Wright: That is very good. Very clever, at 10 o’clock at night.

Tom Blenkinsop: Thank you very much.
	Many operational issues arise from the proposals, relating to, for instance, local, regional and national resilience. I understand that the Fire Officers Association, the Chief Fire Officers Association and the Fire Brigades Union have raised them with officials in the Department
	for Communities and Local Government. I shall focus on four specific concerns. The first is the apparent lack of employee support for the proposals, and the uneasy lack of public awareness. The second is the sheer lack of transparency on the part of both the Government and the fire authority's senior officers. The third is the question of whether a spun-out brigade would raise additional revenue. If so—as a caveat—would such a spin-out have an adverse impact on existing local economy arrangements? Finally, and most importantly, I want to discuss the real risk that these proposals could lead to the privatisation of front-line fire services on Teesside.
	I am a member of the Co-operative party, and a supporter of co-operatives and mutuals. I believe that if a mutual is to function effectively, it will require the support of its members, and that measures should not be forced on a work force. I am not at all convinced that that would be the case in Cleveland, given that the proposals appear to be very much management-driven. The only letters I have received from firefighters in my constituency about this matter strongly oppose the proposals. Indeed, at a single meeting attended by more than 250 firefighters, approximately half the uniformed service in Cleveland, there was unanimous opposition to them. The FBU, which represents some 85% of uniformed fire service workers, has identified a total lack of demand from staff for employee ownership in the fire sector. Instead, there has been “overt hostility”, except from a “smattering of principal managers”. Indeed, I doubt whether there is support even among principal managers, with 40 English chief fire officers and fire chief executives adding their names to the CFOA’s pre-consultation response, which highlighted major concerns with these proposals.
	Even the language used by those promoting the model seems to have been redefined to address the level of employee support. According to the FBU, the model was originally promoted as a John Lewis-style, employee-owned mutual. However, that was only until it became apparent that employees did not want ownership, and nor would they be afforded shares as per that model. The title changed to an “employee-led” mutual, until the vast majority of employees indicated that they did not support the model, and that the only employees who did were a select group of senior managers. The latest title employed is a “locally led” mutual, which in effect acknowledges employee opposition and in doing so employs the term “mutual” as a misnomer.
	Interestingly, one senior local manager has indicated that 51% work force support is the threshold required, although FBU legal advice suggests the fire authority has the ultimate say. It is difficult even to assess the extent to which any spun-out fire brigade would in fact be a mutual, with the authority’s senior officers showing a total disregard for transparency in these proposals. In the authority’s meetings, just about everything related to the proposals has been transacted under “confidential business”, making it impossible for me, my hon. Friends, the media or the public to scrutinise them. Although I believe that the authority will be putting out a business plan to public consultation in due course, I fear it may be presented as a fait accompli. It is indeed remarkable that the authority’s officers, prior to spending tens of thousands of pounds of taxpayers’ money, did not consult stakeholders to ascertain the appetite for these proposals or involve them in setting the terms of reference for the creation of any business plan.
	The Minister may want to say that the authority’s integrated risk management planning has previously stated that it would explore alternative business models, which it did, but only in the most generic terms. What it has not done so far is consult in detail the people of Cleveland. It has not even indicated whether this would be subject to detailed consultation as part of the ongoing IRMP process.
	The Government are doing all they can do to prevent us from analysing these proposals. The fire authority’s senior officers are also providing the bare minimum they can under freedom of information legislation. When my office requested copies of these briefings and their assessment of procurement options for spinning out the brigade, they declined to provide a copy. Amazingly, they argued that it was not in the public interest to do so.

Andrew McDonald: I note my hon. Friend’s comments about the failure to publish the pre-consultation responses. Does he share my concern that the proposal fundamentally to change the basis upon which our fire and rescue service is delivered is being progressed beneath a veil of secrecy? If the scheme is such a good idea, should it not be subject to open and transparent scrutiny, with comprehensive information being shared among all interested parties?

Tom Blenkinsop: I absolutely agree with my hon. Friend, who himself has had to get FOIs and put those letters of information into the House of Commons Library, due to the lack of transparency.
	One of the main genuine reasons why some members of the fire authority are even considering going down this route is their belief that it would mitigate some of the cuts, due to the spun-out body’s ability to bid for private contracts. Also, one of the chief fire officer’s stated aims is job creation. The areas the CFB is exploring are not related to core FRS activity; indeed, these are services currently provided by other sectors. The CFB proposals seek to replace these “others” by providing the same service with their existing work force, thus removing other workers from employment. That in no way can be described as job creation; in fact, it is the very opposite. However, nor do I believe that this would raise any further revenue.

Iain Wright: I congratulate my hon. Friend on securing what is a vital debate for our area. Can he confirm that there is nothing to prevent the community interest company from bidding for existing work? Can he think of anything that, in an effort to secure additional revenue streams, would prevent the current situation from continuing, compared with what a mutual or private model can do?

Tom Blenkinsop: At the meeting mentioned by the hon. Member for Stockton South (James Wharton), the main thrust of the chief fire officer’s argument for seeking a mutual model was to avoid corporation tax. If that is the sole purpose of pursuing the mutual model, one has to assume that the mutual is making a profit, but I want to go into that in more detail. Spending £198,000 from the Department of Health’s social enterprise investment fund, the brigade created an arm’s length company, the Cleveland Fire Brigade Risk Management
	Services community interest company, to bid for contracts from the private and public sector, with any profits to be given to the brigade. However, it operated at a loss of £38,000 in its first year and has already lost a major telecare contract that it had secured six months previously. I am no mathematician, and I do not know what the corporation tax yield would be for the Treasury on a community interest company running at minus £38,000, but with the CIC struggling to make a profit as it is, I fail to see how spinning out the brigade would generate any more contracts or revenue than the current arrangement.
	The most important reason I, along with my hon. Friends the Members for Stockton South, for Hartlepool (Mr Wright) and for Middlesbrough (Andy McDonald), object to the proposals is the scope for privatisation that they permit. I cannot confess to being an expert on the technicalities of European public procurement law, but if the brigade were to be spun out, it would seem almost inevitable that once the initial contract has expired, the authority, as a commissioner, would be obliged to open the process up to competitive tendering, with social value legislation offering little protection. The authority’s senior officers have refused to provide my office with information about the procurement routes it is considering, but none of the “no market”, “joint venture”, “in-house incubation” or “competitive tender” options discussed on the Cabinet Office’s mutuals taskforce website offer protection from competitive tendering in the medium or long term.
	There does not appear to be an appetite from senior officers in anywhere but Cleveland for spinning out the brigade, but the necessary changes to the Fire and Rescue Services Act 2004, which the Minister attempted to push through the Regulatory Reform Committee in a legislative reform order, would, in his own words,
	“enable fire and rescue authorities in England to contract out their full range of services to a suitable provider”.

Ian Lavery: My hon. Friend correctly highlights the fact that the issue was placed in letter form before the Regulatory Reform Committee, of which I am a member. Can he give any explanation for why that was the case?

Tom Blenkinsop: That is precisely why we are here tonight. My hon. Friend makes the valid point about letters on separate issues appearing before the Regulatory Reform Committee with no prior warning. That suggests something going on behind closed doors that we have still not been able to get the documents on in any proper manner.
	I presume these providers could be in the private sector as well as the third sector, which could obviously have effects throughout England. The Minister confirmed that view to the FBU’s parliamentary group only recently. The Labour party supports mutuals, as do I, but the Co-operative party and I feel that this is a wholly inappropriate application of the model. The application does not appear to be the end in itself, but merely a stepping stone to further change. I am sure the Minister can see the difference between mutualising a bailed-out, formerly privately owned bank and mutualising a life-or-death public good such as a fire service.
	I am sure the Minister has a series of quotes ready to fire at me accusing me of scaremongering, but before he does that, I would be grateful if he can clarify one simple point in his response. Specifically, will he absolutely guarantee that if the brigade were to be spun out, a few years down the line, it would not be subject to competitive tender? That would be despite the fact that Cleveland’s own chief fire officer stated that any contract would be subject to competition after the initial contract awarded to any mutual expired. If the Minister can confirm this, will he please inform the House which procurement route would permit this?

Brandon Lewis: Thank you, Mr Speaker, for calling me to speak.
	“From foundation trust hospitals to co-operative trust schools, we are already seeing the benefits that new mutual organisations are bringing to public services. These can provide the efficiency gains of the private sector whilst providing…democratic accountability, giving users, employees and other stakeholders a real say in how their organisations are run. If we are serious about creating a new politics, then giving ordinary people real power over the services that they rely on is the best way to do it.”
	Those words are from the website of the Co-operative party—the party with which the Labour party is in formal coalition.
	I will go further. The Leader of the Opposition has also endorsed mutuals and co-operatives, and the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) said that he does too. The Leader of the Opposition endorsed them in local government in a pamphlet on that very topic. The Labour party’s own local elections launch praised councils for
	“pursuing new co-operative models of service and delivery.”
	I suspect that a party that was true to its word would seek to support Cleveland fire brigade in its mutual bid, rather than playing politics with it.
	Today’s public sector faces huge challenges, and the services that are delivered remain as important as ever. With that in mind, I am somewhat surprised—just as some Members might have been after hearing those quotes—that Opposition Members have been arguing for months in the public domain, and again in the Chamber tonight, against Cleveland’s desire to mutualise. Although I have been lobbied continuously by my hon. Friend the Member for Stockton South (James Wharton) and although the hon. Member for Wansbeck (Ian Lavery) has approached me in a meeting, I am surprised that the hon. Member for Middlesbrough South and East Cleveland, if he feels so strongly about the issue, has not come to see me to talk to me about it or to raise any of the concerns that he has just raised tonight. If he felt that strongly, I would have thought that he would have come to see me or asked to see me some time ago, when I could have explained the situation to him. We have done so publicly on a number of occasions and I will do so again tonight.
	Fire and rescue authorities, like other organisations, need to innovate and to change in order to make the efficiencies that they want and need to find while continuing to deliver excellent services to the communities they serve. Being open to new ways of working is an important part of that and we are supporting those fire and rescue authorities that want to innovate and look for new delivery models, such as locally led mutuals.
	At their heart, mutuals will give front-line staff a real stake in the ownership and governance of the organisations they work for. Giving front-line staff the power to do their jobs in the way that they know is best, as well as the power to be responsive to the needs of individuals, can create better, more efficient public services while feeding the benefits back to communities.

Alex Cunningham: Will the Minister answer this simple question: does he agree with the chief fire officer of Cleveland that after the initial contract—be that for three, four or nine years—any contract would be open to competition from any suitable provider at that stage?

Brandon Lewis: If the hon. Gentleman will bear with me, I will answer that question directly: it is on the assumption that the chief fire officer can go down that route in the first place. I made a statement to the FBU parliamentary group—the hon. Member for Wansbeck was there—in which I made it clear that we would not go down the route of allowing somebody to privatise a front-line fire service. I will return to that point in a few moments.

Richard Fuller: The Minister is talking about the requirement for the fire service to innovate. As the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) said, the process for Cleveland was stimulated by an £8.9 million funding gap. Does the Minister accept that organisational tinkering, which raises serious concerns that are, I think, shared by all parties in the House, is perhaps not as good a route as looking at different ways of putting additional services through the infrastructure of our fire service and its assets? Would taking that route not solve the problem and address some of the concerns that have been raised by Opposition Members?

Brandon Lewis: It is absolutely right that a number of different authorities are looking at different ways of moving forward and at how they work. I will discuss that in just a few moments, if my hon. Friend will bear with me.
	Let us look at some examples. City Health Care Partnership community interest company in Hull provides front-line health services. It has delivered £600,000 worth of savings a year while delivering a significant improvement in patient satisfaction and a number of new services. Since it mutualised in 2011, Project Salus, a provider of children’s and youth services, has grown by around 30% and increased spending on front-line services by 10%.
	The Government have a role to play in encouraging innovation and efficiency in the public sector and in creating the right conditions for organisations to explore options such as becoming mutuals. We are creating new opportunities for public sector workers to take over the running of services in many areas, including health services, adult social care and social work, youth services, Sure Start children’s centres and probation services.
	In the last two years the number of public service mutuals has jumped from just 10 to 70 under this Government, not a Labour Government, delivering so far about £1 billion-worth of public services. There has previously been support from across the political spectrum for co-operatives and mutuals in local government, although I appreciate that tonight in some areas, for
	reasons of political expediency, that seems to have changed. Indeed, the Communities and Local Government Committee recently called on the Government to do more to support the development of mutuals and co-operatives in local government.

Andrew McDonald: rose—

Tom Blenkinsop: rose—

Brandon Lewis: I will give way first to the hon. Member for Middlesbrough (Andy McDonald).

Andrew McDonald: The Minister is extolling the virtues of mutualisation for this service, but on 17 December he received a letter from the Chief Fire Officers Association—I do not know whether he has replied—which says:
	“Whilst we can see why the mutual delivery model may be attractive for some public services, we are concerned about its suitability for the delivery of an emergency service.”
	We are talking about putting out fires; we are talking about mutualising, on the road to privatisation, to put out fires. Can the Minister not understand why people think this is not the right route to go down?

Brandon Lewis: I shall now give way to the hon. Member for Middlesbrough South and East Cleveland.

Tom Blenkinsop: I am not going to respond to personal digs, but I will say that I met the Minister’s predecessor on more than one occasion about concerns relating to the CIC. Opposition Members were concerned about that and wanted to be constantly fed information so they could know what was happening and disseminate information to their constituents. However, in recent months we have certainly not had that from this Department.
	I will read to the Minister a quote from the Secretary of State for Communities and Local Government reported on 20 March in The Northern Echo:
	“If that means we cannot move on mutualisation, we will not move on mutualisation—if that means privatisation of the fire service. Have I left any room for manoeuvre?”
	Would the Minister like to comment on that?

Brandon Lewis: Yes, that is absolutely the position, which is why I said that the hon. Gentleman is somewhat behind the times. We have made our position very clear, and in the six months or so that I have been involved in this issue, he has not approached me on it. I was also slightly surprised today when I spoke to the Labour chairman of the fire authority to learn that he had not been approached by the hon. Gentleman about tonight’s debate. I spoke to the chairman today to pay him the courtesy of confirming our position and what I would be saying.
	It is disappointing that Her Majesty’s Opposition have not, on the whole, been supportive of mutualisation in the fire and rescue service. It is all very well Opposition Members making comments such as those that the hon. Gentleman just made, but the reality is that they have not been supportive whereas this Government are looking to do what we can to help mutuals move forward.
	The Labour party has been distorting our support for fire and rescue authorities that are considering mutualisation by painting it as privatisation. As the hon. Gentleman
	himself eloquently outlined, we have made our position very clear: if this allows for privatisation, we simply will not let it happen. Mutualisation transcends the old binary distinction between in-house and privatised public services. Cleveland’s own local authority chairman, who is a Labour councillor, has described these claims as “scaremongering”. There has been an orchestrated campaign of misinformation in the media, which has wrongly played on peoples’ fears, and I want to correct that today. For the Labour party to start a campaign to stop something that was never happening in the first place is an achievement even for it. My aim is to support fire and rescue authorities in delivering excellent services to their communities, and I will do all in my power to help them do that.

Tom Blenkinsop: I genuinely hope the Minister will take this opportunity to stop the strategy of stonewalling, as a result of which we have received no answers to freedom of information requests or questions in this House, and answer the final question in my speech: will he guarantee that there is no route via mutualisation that will allow for privatisation, as outlined by the chief fire officer to us at a recent meeting? I ask that as the Conservative party is currently in the throes of anger over Europe and is enthralled by European competition law that allows privatisation of a public sector service.

Brandon Lewis: The hon. Gentleman can try to spin this whichever way he wants, but he has already eloquently outlined our position. He quoted the Secretary of State and I was present when he said that if there is no way of mutualising without opening the door to privatisation, we will not do it. Cleveland will not be able to go down the road of becoming a mutual with the help of the Government unless we can find a way of doing it that does not open the door to privatisation. That is why I made the point about the Labour party campaigning on a route we were never going down in the first place.

James Wharton: This is very important, because I am sure that a lot of Cleveland firefighters are watching this debate or will follow it up. In my discussions with my hon. Friend, we have talked not only about the risks of privatisation and why the Government are against it, but the employment rights and conditions of the firefighters who work there. Whatever the Government allow to happen, will he confirm that we will protect those as best we can and not let them be put at risk?

Brandon Lewis: My hon. Friend makes a good point. Yes, of course we will.
	Let me be very clear about this. Cleveland, a Labour authority with a Labour fire authority chairman, has come to the Government wanting to mutualise. We have said that we will work with the authority if we can find a way for it to do that, should it need the Government to take action to allow it. We will not do that unless we are confident that there is a way to do it that does not open the door to privatisation. That position has not changed since the beginning and it remains unchanged. Cleveland expressed an interest in exploring mutualisation to deliver services. Let us remember that under the 2004 Act, introduced by the Labour Government, many
	fire services can already be provided through private procurement and through mutuals or other bodies, if they wish it.
	The wider sector has shown an interest in having the flexibility to do things differently, and authorities across the country are looking at how they can innovate. In such a scenario the authority would, however, retain its responsibilities in statute for delivering the important public service that fire authorities deliver. A mutual would generally be free from the restrictions of the public sector and be able to design services in a way that better meets the needs of their local communities, harnessing the energies and expertise of the front-line staff who are the real experts in the services that they deliver. Benefits can flow back to the community in terms of a better designed service, delivering it more efficiently and giving new opportunities for community engagement and involvement.
	Cleveland identified some barriers that were preventing it from taking this step, and as the Government it is right that we should look into whether we can help to consider this innovative delivery option. We have undertaken an initial consultation with key partners to understand the issues at hand. Following that, we approached the Chair of the Regulatory Reform Committee to consider whether it would be appropriate to make any changes to existing legislation. In my view, raising this issue on behalf of the fire and rescue authorities was essential to inform our understanding of the potential barriers, challenges and benefits to the fire sector. To avoid the topic completely would have been wrong. Just because a question is new and different does not mean that we should be afraid to ask it.
	Let me be clear: the No. 1 priority of every fire and rescue authority is, and always will be, preventing fires and saving lives, and this Government will continue to support them in this essential life-saving role.

Tom Blenkinsop: rose—

Brandon Lewis: I am going to make some more progress given the time.
	The key point is that we have listened to the responses and, following feedback, we have made it abundantly clear that despite the claims of the Labour party, we are not, as the hon. Member for Middlesbrough South and East Cleveland clearly outlined in the quote by the Secretary of State, selling off the sector. My aim remains to support fire and rescue authorities in exploring new and innovative ways of providing their services, and we are reviewing the options to enable such models without opening up the delivery of key fire and rescue services to outside parties.

Alex Cunningham: Will the Minister give way?

Brandon Lewis: No, I will not, in view of the time.
	Mutuals are also being considered as part of a wider review generally, in the case of the fire and rescue sector by Sir Ken Knight, whose report will be published shortly. However, mutuals are not the only innovative delivery model that fire and rescue authorities are considering. Some are exploring other opportunities that deliver benefits for their communities, while others are looking at closer joint working and sharing of resources within both the fire sector and the wider blue
	light community. Increased collaboration and partnership are excellent principles that all parties, whatever their political view, should endorse.
	Cleveland fire and rescue authority, and others of its kind, should be lauded for exploring pioneering options for delivering its services for the benefit of its staff and, importantly, the community it serves. It, a Labour-controlled authority, has recognised the need to work in different ways and is seemingly not afraid to try new things in order to meet the challenges that the public sector faces and to do the best for its community.
	I hope that I have responded to all my colleagues’ concerns. We may not agree on things, but the simple
	fact is that the Cleveland authority has asked us to look at something and we have said that we will do so. All parties should be working together to support Cleveland and any other fire and rescue authority that is trying to do something new and innovative for the benefit of its community. This is, and always has been, about giving the fire sector the freedom and flexibility to save lives and to deliver the excellent service that they provide to their communities.
	Question put and agreed to.
	House adjourned.